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Раздел 93 / 94
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IV. CLINICO-LABORATORY CASES

HYPOXIA

Normal parameters of the arterial blood gases

Patm - 750-765 mm Hg (atmospheric pressure).

PatmO2 - 150-160 mm Hg (partial pressure of O2 in the atmosphere).

PalvO2 - 105-110 mm Hg (partial pressure of O2 in the alveolar air).

PaO2 - 95-100 mm Hg (partial tension of O2 in the arterial blood).

PvO2 - 35-50 mm Hg (partial tension of O2 in the venous blood).

PaCO2 - 35-42 mm Hg (partial tension of CO2 in the arterial blood).

SaO2 - 96-98% (saturation of the arterial blood by O2).

SvO2 - 60-70% (saturation of the venous blood by O2).

Oxygen-carrying capacity - 16.0-23.0 vol%.

Pulmonary minute volume - 6-8 L/min.

Circulation minute volume - 5-6 L/min.

Define the type of hypoxia and explain its possible cause(s) and mechanisms of development.

N 146

N 147

PatmO2 - 160 mm Hg

PatmO2 - 158 mm Hg

PalvO2 - 105 mm Hg

PalvO2 - 105 mm Hg

PaO2 - 96 mm Hg

PaO2 - 95 mm Hg

PvO2 - 60 mm Hg

PvO2 - 38 mm Hg

PaCO2 - 30 mm Hg

PaCO2 - 40 mm Hg

SaO2 - 98%

MetHb - 40%

SvO2 - 91%

SaO2 - 70%

Pulmonary min. volume - 7.3 L/min

SvO2 - 20%

Circulation min. volume - 6.9 L/min

Pulmonary min. volume - 8.8 L/min

pH - 7.31

Circulation min. volume - 7.0 L/min

Lactic acid - 26.5 mg/dl

pH - 7.30

Lactic acid - 20.5 mg/dl

N 148

N 149

PatmO2 - 150 mm Hg

PatmO2 - 158 mm Hg

PalvO2 - 94 mm Hg

PalvO2 - 105 mm Hg

PaO2 - 76 mm Hg

PaO2 - 96 mm Hg

PvO2 - 21 mm Hg

PvO2 - 18 mm Hg

PaCO2 - 48 mm Hg

PaCO2 - 28 mm Hg

SaO2 - 90%

Hb - 140 g/L

N 148

N 149

SvO2 - 32%

SaO2 - 95%

Pulmonary min. volume - 4.6 L/min

SvO2 - 27%

Circulation min. volume - 6.4 L/min

Pulmonary min. volume - 8.8 L/min

pH - 7.31

Circulation min. volume - 2.9 L/min

Lactic acid - 25 mg/dl

pH - 7.31

Lactic acid - 26.5 mg/dl

N 150

N 151*

PatmO2 - 105 mm Hg

PatmO2 - 158 mm Hg

PalvO2 - 55 mm Hg

PalvO2 - 88 mm Hg

PaO2 - 40 mm Hg

PaO2 - 61 mm Hg

PvO2 - 12 mm Hg

PvO2 - 16 mm Hg

PaCO2 - 58 mm Hg

PaCO2 - 59 mm Hg

SaO2 - 67%

SaO2 - 88%

SvO2 - 11%

SvO2 - 25%

Pulmonary min. volume - 4.5 L/min

Pulmonary min. volume - 2.85 L/min

Circulation min. volume - 3.4 L/min

Circulation min. volume - 8.50 L/min

pH - 7.28

pH - 7.25

Titratable acidity of the daily urine - 60 mmol/d

Hb - 140 g/L

N 152

N 153

patmO2 - 160 mm Hg

patmO2 - 155 mm Hg

palvO2 - 109 mm Hg

palvO2 - 104 mm Hg

paO2 - 96 mm Hg

paO2 - 95 mm Hg

pvO2 - 41 mm Hg

pvO2 - 36 mm Hg

paCO2 - 30 mm Hg

paCO2 - 34 mm Hg

SaO2 - 67%

SaO2 - 96.5%

SvO2 - 18%

SvO2 - 65%

Hb,g/L - 142

Hb,g/L - 38

Pulmonary min. volume - 8.0 L/min

Pulmonary min. volume - 8.5 L/min

Circulation min. volume - 5.7 L/min

Circulation min. volume - 6.8 L/min

pH - 7.34

pH - 7.36

Lactic acid - 20.2 mg/dl

Lactic acid - 17.2 mg/dl

ACID-BASE DISORDERS

Normal parameters of the acid-base homeostasis of the capillary blood

Parameter

Value

pH

7.36-7.45

pCO2

6-45 mm Hg

B

21-25 mmol/L

BB

45-52 mmol/L

BE

+/- 2.4 mmol/L

Ketone bodies

0.5-2.5 mg/dl

Lactic acid

6-16 mg/dl

Titratable acidity (of the daily urine)

20-40 mmol/24 hours

NH4+ (of the daily urine)

30-50 mmol/24 hours

Define the type of acid-base disorder and explain its possible mechanism of development.

N 154

N 155

pH - 7.18

pH - 7.25

pCO2 - 75 mm Hg

pCO2 - 52 mm Hg

SB - 27 mmol/L

SB - 22 mmol/L

BE - +2.5 mmol/L

BB - 45 mmol/L

BE - +2 mmol/L

The patient is undergoing surgical operation with cardiopulmonary bypass

The patient has a bronchial asthma attack

N 156*

N 157

pH - 7.20

pH - 7.36

pCO2 - 37 mm Hg

pCO2 - 36 mm Hg

SB - 14 mmol/L

SB - 19.5 mmol/L

BB - 29 mmol/L

BB - 39 mmol/L

BE - - 12 mmol/L

BE - - 5 mmol/L

Ketone bodies - 7.5 mg/dl

The patient is undergoing surgical operation with cardiopulmonary bypass

Titratable acidity - 37 mmol/24 hours The patient suffers from diabetes mellitus

N 158

N 159

pH - 7.30

pH - 7.30

pCO2 - 38 mm Hg

pCO2 - 35 mm Hg

SB - 18 mmol/L

SB - 16.5 mmol/L

BB - 36 mmol/L

BB - 35 mmol/L

BE - - 6 mmol/L

BE - - 9 mmol/L

Lactic acid - 26 mg/dl

Titratable acidity - 8 mmol/24 hours

Titratable acidity - 45 mmol/24 hours

NH4+ - 17 mmol/24 hours

The patient is admitted to hospital with a preliminary diagnosis of an acute myocardial infarction

The patient suffers from an acute glomerulonephritis

N 160

N 161

pH - 7.22

pH - 7.22

pCO2 - 36 mm Hg

pCO2 - 47 mm Hg

SB - 14 mmol/L

SB - 18.5 mmol/L

BB - 24 mmol/L

BB - 40.5 mmol/L

BE - - 8 mmol/L

BE - - 7 mmol/L

Lactic acid - 28 mg/dL

Titratable acidity - 8 mmol/24 hours

NH4+ - 15 mmol/24 hours

The patient has intestinal fistula; he has been losing intestinal juice for a long period of time

The patient suffers from severe toxic injury of the liver and kidneys with oligouria

N 162

N 163

pH - 7.11

pH - 7.17

pCO2 - 50 mm Hg

pCO2 - 51 mm Hg

SB - 15.5 mmol/L

SB - 18 mmol/L

BE - -13 mol/L

BB - 45 mmol/L

BB - 38 mmol/L

BE - - 8 mmol/L

Ketone bodies - 58 mg/dL

Titratable acidity - 70 mmol/24 hours

The patient has coma

The patient suffers from an acute left ventricular insufficiency with lungs edema

N 164

N 165

pH - 7.52

pH - 7.51

pCO2 - 25 mm Hg

pCO2 - 36 mm Hg

SB - 20 mmol/L

SB - 28 mmol/L

BE- - 2 mmol/L

BB - 57 mmol/L

BB - 40 mmol/L

BE - +5.5 mmol/L

The patient is undergoing surgery with mechanical ventilation

The patient suffers from uncontrolable vomiting, tetanus

N 166

N 167

pH - 7.59

pH - 7.27

pCO2 - 30 mm Hg

pCO2 - 25 mm Hg

SB - 28 mmol/L

SB - 11 mmol/L

BE - +5 mmol/L

BB - 27 mmol/L

BB - 50 mmol/L

BE - - 17 mmol/L

Hematocrit - 0.36

The patient with brain contusion has cyclic vomiting and dyspnea

The patient had an acute blood loss

N 168

N 169

pH - 7.22

pH - 7.33

pCO2 - 49 mm Hg

pCO2 - 35 mm Hg

SB - 19.5 mmol/L

SB - 18 mmol/L

BE - - 3 mmol/L

BB - 42 mmol/L

BB - 44 mmol/L

BE - - 5.5 mmol/L

Lactic acid - 23 mg/dL

Titratable acidity - 12 mmol/L

Titratable acidity - 15 mmol/24 hours

Hematocrit - 0.3

The patient has been transported to the intensive care unit after surgical removal of thrombus in the abdominal aorta

The patient has been admitted to hospital with a diagnosis of hemolytic anemia of unclear etiology

N 170

N 171

pH - 7.57

pH - 7.45

pCO2 - 28 mm Hg

pCO2 - 30 mm Hg

SB - 25 mmol/L

SB - 20 mmol/L

BE - +4 mmol/L

BB - 50.5 mmol/L

BB - 48 mmol/L

BE - - 0.5 mmol/L

Lactic acid - 12 mg/dL

Hematokrit - 0.4

Titratable acidity - 20 mmol/24 hours

The patientsuffers from brain contusion and bouts of vomiting

The patient has had the hysteria hyperventilation episode just before the analysis

N 172

N 173

pH - 7.09

pH - 7.36

pCO2 - 51 mm Hg

pCO2 - 49 mm Hg

SB - 15 mmol/L

SB - 26.5 mmol/L

BE - - 12.5 mmol/L

BB - 52.5 mmol/L

BB - 38 mmol/L

BE - +6 mmol/L

Lactic acid - 25 mg/dL

Titratable acidity - 18 mmol/24 hours

Titratable acidity - 18 mmol/24 hours

The patient was admitted to hospital 9 days before with myocardial infarction

The patient suffers from purulent peritonitis a diagnosis of acute

PATHOPHYSIOLOGY OF THE BLOOD SYSTEM

Normal results of the complete blood test with differential

Hemoglobin (Hb) - 130-160 g/L (men); 120-150 g/L (women).

Erythrocytes - 4.2-5.9Ч1012/L (men); 3.9-4.6Ч1012/L (women).

Mean corpuscular Hb (MCH) - 25-33 pg.

Reticulocytes - 0.5-2.5%.

Platelets - 150-350Ч1012/L.

Leukocytes - 4.5-10.5Ч109/L.

Neutrophils:

myelocytes - 0;

metamyelocytes - 0;

band - 1-6%;

segmented - 47-72%.

Eosinophils - 2.0-4.0%.

Basophils - 0.5-1%.

Lymphocytes/plasmocytes - 20-25%/0.

Monocytes - 3-8%.

Erythrocytes sedimentation rate (ESR) - 1-13 mm/h (men); 1-20 mm/h (women).

Hematokrit (Ht) - 0.45-0.52 (men); 0.37-0.48 (women)

Characterize changes in the complete blood tests with differential, and indicate their possible causes, mechanisms of development and consequences. Make a general conclusion on the results of tests.

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