Case Study
1. What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD?
Chronic bronchitis, also known as type B COPD or “blue bloater” in most cases (90%) is caused by cigarette smoking with the typical patient being overweight. It is symptomatically diagnosed with a conformation of chest radiography showing increased bronchial vascular markings, congested lung fields, enlarged horizontal cardiac silhouette and evidence of previous pulmonary infection (this is why RS’s right lower lobe is thought to be consistent with pneumonia). As well pulmonary function tests show normal total lung capacity, increased residual volume, and decreased FEV. Arterial blood gas evaluation may show elevated PaCO2 and decreased PaO2 (often below 65mm Hg). Secondary polycythemia related to continuous or nocturnal hypoxemia is common, which leads to a compensatory production of red blood cells in an attempt to carry more oxygen to the body tissues. Emphysema, also known as type A COPD or “pink puffer” is rather than being symptomatically diagnosed, is pathologically defined. It is however, typically associated with chronic bronchitis. Patients also typically have a smoking history, and rather than being overweight are thin and may or may not show sings of pneumonia with a chest x-ray. Upon having type A COPD, arterial blood gas values typically reveal a normal mild decrease in PaO2 (65-75 mmHg) and a normal (or in late stages, elevated) PaCO2
2. Interpret R.S.’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia? For normal adults, arterial blood gas levels include PaCO2 36-44 mmHg, HCO3- 22-26 mEq/L, and pH 7.35-7.45. With that being said, RS has increased levels of PaCO2 and HCO3- with a decreased pH level thus leading to the conclusion that RS is in respiratory acidosis. His PaCO2 level is increased because of impaired gas exchange, and HCO3-
Chronic bronchitis, also known as type B COPD or “blue bloater” in most cases (90%) is caused by cigarette smoking with the typical patient being overweight. It is symptomatically diagnosed with a conformation of chest radiography showing increased bronchial vascular markings, congested lung fields, enlarged horizontal cardiac silhouette and evidence of previous pulmonary infection (this is why RS’s right lower lobe is thought to be consistent with pneumonia). As well pulmonary function tests show normal total lung capacity, increased residual volume, and decreased FEV. Arterial blood gas evaluation may show elevated PaCO2 and decreased PaO2 (often below 65mm Hg). Secondary polycythemia related to continuous or nocturnal hypoxemia is common, which leads to a compensatory production of red blood cells in an attempt to carry more oxygen to the body tissues. Emphysema, also known as type A COPD or “pink puffer” is rather than being symptomatically diagnosed, is pathologically defined. It is however, typically associated with chronic bronchitis. Patients also typically have a smoking history, and rather than being overweight are thin and may or may not show sings of pneumonia with a chest x-ray. Upon having type A COPD, arterial blood gas values typically reveal a normal mild decrease in PaO2 (65-75 mmHg) and a normal (or in late stages, elevated) PaCO2
2. Interpret R.S.’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia? For normal adults, arterial blood gas levels include PaCO2 36-44 mmHg, HCO3- 22-26 mEq/L, and pH 7.35-7.45. With that being said, RS has increased levels of PaCO2 and HCO3- with a decreased pH level thus leading to the conclusion that RS is in respiratory acidosis. His PaCO2 level is increased because of impaired gas exchange, and HCO3-