A patient suffering with hypoventilation due to a severe infection is measured to have significant blood?

Question

acidosis (pH 6.90) that requires immediate intervention. Which of the following strategies would be most effective to regulate normal blood pH:

a. Decrease CO2 levels (PCO2) through active ventilation
b. Titrate blood with a slow infusion of NH4Cl (aq)
c. Increase CO2 levels (PCO2) through active ventilation
d. Titrate blood with a slow infusion of HCl (aq)
e. Consult a chemist

Answer 1

My choice is letter A. Decrease CO2 levels (PCO2) through active ventilation..

Respiratory acidosis is an imbalance between carbon dioxide (CO2) production by the body and excretion by the lungs. The goals of therapy therefore are to remove the underlying cause and return the PaCO2 to baseline. If hypoxemia accompanies hypercapnia, oxygen should be administered.

In chronic hypercapnia, supplemental oxygen therapy can worsen the situation by reducing the respiratory drive and increasing dead-space ventilation due to a loss of hypoxic pulmonary vasoconstriction. In such case mechanical ventilation may be required.

Answer 2

Mechanically ventilate, blow off the excess CO2. If your patient has a pure respiratory acidosis (unlikely, but it's a starting point) you'd anticipate the pCO2 would be 100 or a bit over, compared to a normal of 40.
The way I remember it from medical school, air goes in and out, blood goes round and round, and if either of those don't happen, it usually ain't good. (And it's a good idea not to get those mixed up.) In this case, the first isn't happening and ought to be fixed.

Answer 3

Your patient sounds like he's very sick and needs to be transfered to the ICU for mechanical ventilation. In a pure respiratory acidaemia, which is unlikely in his case, the additional ventilation will help to address he pH, but such an ill patient cannot be adequately monitored on a general medical floor and deserves to be upgraded to ICU.