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Клиническая патофизиология : курс лекций, тесты, задачи = Clinical pathophysiology : сoncise lectures, tests, cases

IV. CLINICO-LABORATORY CASES

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HYPOXIA

Normal parameters of the arterial blood gases

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

P_atmO₂ - 150-160 mm Hg (partial pressure of O₂ in the atmosphere).

P_alvO₂ - 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
P_atmO₂ - 160 mm Hg	P_atmO₂ - 158 mm Hg
P_alvO₂ - 105 mm Hg	P_alvO₂ - 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
P_atmO₂ - 150 mm Hg	P_atmO₂ - 158 mm Hg
P_alvO₂ - 94 mm Hg	P_alvO₂ - 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*
P_atmO₂ - 105 mm Hg	P_atmO₂ - 158 mm Hg
P_alvO₂ - 55 mm Hg	P_alvO₂ - 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
p_atmO₂ - 160 mm Hg	p_atmO₂ - 155 mm Hg
p_alvO₂ - 109 mm Hg	p_alvO₂ - 104 mm Hg
p_aO₂ - 96 mm Hg	p_aO₂ - 95 mm Hg
p_vO2 - 41 mm Hg	p_vO₂ - 36 mm Hg
p_aCO₂ - 30 mm Hg	p_aCO₂ - 34 mm Hg
S_aO₂ - 67%	S_aO₂ - 96.5%
S_vO₂ - 18%	S_vO₂ - 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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