question about acidotic pts and labs

questionsforall · Apr 23, 2010

Need more info, (like maybe the complete blood gas). However, you said he was a renal patient with phos of 12. I would need more labs like BUN, creatinine to say this, but maye he needed dialysis. It sounds like his CO2 was low, maybe he was compensating for a metabolic acidosis by breathing fast (since you said he was SOB) and blowing off CO2.

XingtheBBB, BSN, RN · Apr 23, 2010

I assume that was CO2 in a Chem 7, not CO2 in an ABG? Whole different concept there. Chem 7 CO2 is representative of bicarbonate, not acid and reflects the acidosis. Pt probably went to ICU to be vented and started on a bicarb drip.

... more later if no-one chimes in ... kids need me ...

crystalchen · Apr 23, 2010

yes, that was CO2 in his Chem7. What's the differences between CO2 in chem 7 and in ABG? I could not remember his other lab values... They were deciding if he should go to dialysis or ICU first and then decided he should go to ICU. He was actually almost on his way to dialysis this morning. They didn't know why his BG dropped so low, he is not a diabetic and they asked me twice if he received any insulin. He also had an episode of low BG yesterday in dialysis so he only went for 2 hours and came back. There was some mental status changes noticed from yesterday to today per wife. Please write more!! Thank you

MedicineCNS · Apr 23, 2010

Why was he admitted to the hospital? Infection? any cancer? Sounds like liver involvement to me. Lactate was high because he was running on that anaerobic metabolism thing :) sob was r/t him trying to blow off the co2 from being in lactic acidosis.

netglow, ASN, RN · Apr 23, 2010

Curious, as this was suspect in one of my clinical situations. What age are we talkin? Is the spouse Diabetic? You get where I am going...

XingtheBBB, BSN, RN · Apr 23, 2010

If it was me sent to him on a rapid response team, I would suggest ICU and call dialysis to set up a machine there.

I wondered, too, about that sugar! I even wondered if you were from Australia or UK since I don't remember how that system works.

This is a rough idea of serum CO2 vs ABG PCO2- I'm hazy on details myself. Hopefully someone offers an easy clear explanation for us both. Serum COz measures ALL forms of CO2 in the serum including (or rather, mostly) HCO3- which breaks down during testing. PCO2 is the dissolved "pure" acidic CO2 that should be excreted by the lungs.

ESRD kidneys are not making the bicarb the body needs for balance.

High PO4 is consistent with renal failure- kidneys aren't excreting what they should. At that level, it's likely that Ca+ is falling.

Surely, in that acidic environment, K+ was high, too?

Lactate reflects that cells are hypoxic and in anaerobic metabolism. Acidotic blood doesn't give away O2 easily.

ESRD pts continue to shock us with the wacky lab values that their bodies come to accept.

crystalchen · Apr 23, 2010

he was admitted for SOB at home, he tried on a cpep mask and was planned to have that machine home this Friday because he always wakes up at night because of SOB and I noticed he had to move from bed to chair and many different positions to sleep during my shift. You answered my question about the lactate and Co2s.... thank you!!! yeah his K was high before yesterday's dialysis but then after that 4 lab draws could not run that K test because hemolyzed... his blood was like... very dark blue color this morning!

I didn't know if the spouse has diabetes. He is in the 60s,sponse is a lpn worked in a school clinic for 20 years...

Could you explain more on this please?"Lactate reflects that cells are hypoxic and in anaerobic metabolism. Acidotic blood doesn't give away O2 easily".

Thanks a lot!

ps i am from China, but i was educated and working here in the US :)

MedicineCNS · Apr 23, 2010

Lactate is a byproduct of anaerobic metabolism. When muscles organs etc run with out enough 02 it builds up... The reason your muscles burn after a run. We use lactate as a measure of tissue perfusion.

meandragonbrett · Apr 23, 2010

in anaerobic metabolism. Acidotic blood doesn't give away O2 easily.

Look up the oxy-hemoglobin curve. It will explain what situations cause hgb to hold onto or release O2 to the tissues.

As others have said, lactic acid is used generally as a trending tool during resus to monitor tissue perfusion. Go back to your Kreb's cycle and you'll find that lactic acid is a result of anaerobic metabolism.

XingtheBBB, BSN, RN · Apr 23, 2010

yeah his K was high before yesterday's dialysis but then after that 4 lab draws could not run that K test because hemolyzed... his blood was like... very dark blue color this morning!

Yuck. I've seen that blood. Never in someone with your pt's mental status and VS though. Acidotic and hypoxemic. Do you know what the pH was? I've seen that sludgy blood in the 7.0-7.1 range. Makes me think that whatever value lab was getting when they said "hemolysed" was accurate to what was circulating.

Could you explain more on this please?"Lactate reflects that cells are hypoxic and in anaerobic metabolism. Acidotic blood doesn't give away O2 easily".

Like the pp said, look at the oxy-hemoglobin dissociation curve. It's hard to explain in words without the graph. I can't believe no one corrected me... Acidotic blood doesn't bind to oxygen easily. Once at the cells, it gives up what it has. At the lungs, however, hemoglobin has trouble accepting oxygen. Regardless, we see the effects of cells not receiving enough O2 when we look at the lactic acid (lactate)

XingtheBBB, BSN, RN · Apr 23, 2010

Does anyone know why I can't seem to edit my previous post? I don't want it causing further confusion!