both respiratory and metabolic acidosis - possible?

Traumajunkie91 · Jul 6, 2015

I think it is partially compensated metabolic acidosis. It is not fully compensated, as the ph would have to be normal for that to be so. I could be wrong but as I remember it, if the ph and hco3 are going in the same direction (both are going down = acidosis) then it is a metabolic problem. If I am wrong, someone correct me as I don't know what else it could be :bookworm:

aeris99 · Jul 6, 2015

I would call that uncompensated resp acidosis.

Check out

Have a notebook and pencil handy. Follow along, pause the video, do the work and check your answers.

It makes sense after you do a few sets.

aeris99 · Jul 6, 2015

Sorry posted too fast.

It's uncompensated because the ph is not in normal range. Compensated means that the compensatory system is doing enough work to hold the ph at normal or to offset the other system.

HTH!

KatieMI, BSN, MSN, RN · Jul 7, 2015

Yes, respiratory and metabolic acidosis may coexist, although if things run long enough, there can be partial compensation, if patient has reserves. A relatively common case is patient with insulin dependent diabetes getting severe pneumonia (acute respiratory acidosis) , losing control of sugars and going into DKA (acute metabolic acidosis). Wrong vent management in case of acute metabolic acidosis with not enough ventilation to exhale CO2 is another common thing.

The labs described are about decompensated patient, as he is clearly out of all lines.

MunoRN, RN · Jul 7, 2015

It's "mixed" respiratory and metabolic acidosis; both are out of normal range and are in the direction of acidosis. If the CO2 was elevated and the Bicarb was also elevated then that would be compensated or partially compensated respiratory acidosis since the elevated Co2 is causing acidosis and the elevated bicarb is trying to decrease the acidosis.

Mavrick, BSN, RN · Jul 7, 2015

Definitely uncompensated because pH is not in "normal" range 7.35 - 7.45.

So what do we have here, a septic diabetic in heart failure?

Cirrhotic COPD'er on wrong vent setting? It is July after all.

Wile E Coyote, ASN, RN · Jul 11, 2015

Yes, very possible.

That would be referred to as mixed acidosis in my area.