please help with these ABG's

Hmmmm. This sounds like metabolic alkalosis to me. There is some respiratory compensation going on. Any other history? N/V, NG to suction? Without knowing more I couldn't say what is causing this, but I don't think Respiratory is the cause. Any ABG experts out there?

thanks for your reply. a little more info--pt was getting lasix ivp, i think q 12 hours. BUN and creatinine were climbing but no history of renal dysfunction.

Sounds like your pt was going into acute renal failure...probably why they were rataining HCO3. I would guess metablolic alkalosis as well. Lungs may have been trying to hold on to CO2 to correct. I would like to hear some more experienced opinions as well.

asoldierswife, I think in acute renal failure the patients are usually in metabolic acidosis and the bicarb levels are low. We frequently have to supplement bicarb with renal patients from what I've seen. But I believe that lack of kidney perfusion can cause it. (Trying to remember my patho class. LOL)

I agree that this patient looks more like a metabolic alkalosis. Given the fact the patient is on lasix, I wonder what his K levels are, as met. alk. is associated with hypokalemia sometimes. Low chloride levels from diuretic use can be a cause.

K level was low and pt was experiencing muscle twitching, which I know is a symtom of met. alkalosis.

Thank you all for your input. I hadn't thought about kidneys being the problem.

I wonder why the experienced RT thought this was a respiratory problem?

asoldierswife, I think in acute renal failure the patients are usually in metabolic acidosis and the bicarb levels are low. We frequently have to supplement bicarb with renal patients from what I've seen. But I believe that lack of kidney perfusion can cause it. (Trying to remember my patho class. LOL)

Thanks...I was questioning that but I am a novice at ABG interpretation as well.

Would the lasix compound the problem? With a high C02 level on 90% bipap...do you think this pt needs to be ventilated?

Yep, I would guess that the lasix is the culpret. I'm wondering why he's getting lasix with a diagnosis of pneumonia. Anyway, this guy needs IV fluids and K+ replacement. Might want to check a magnesium level. Also watch his Rhythm while his electrolytes are so screwed up. Hats off to you for questioning the Nurse and RT. The doctor needs to be notified of these results! What a great learning experience for you!

Thanks...I was questioning that but I am a novice at ABG interpretation as well.

Would the lasix compound the problem? With a high C02 level on 90% bipap...do you think this pt needs to be ventilated?

I think definately one needs to look at the lasix as perhaps causing electrolyte imbalances which might have thrown this person into this condition.

I'm not sure about intubation as I am not sure when they decide to intubate, but the p02 of 64 is very worrisome and might warrent intubation. Again, I bow to the experts on this one.

Good questions and good learning experiences for us all.

Doc was notified of results by RT. Vent not an option for this pt as he was made partial DNR the day before.