The 56-year-old intubated and sedated patient’s arterial blood gas results are as follows: pH = 7.25, PCO2 = 36, PaO2 = 50, HCO3- = 15, SaO2 = 86%. Other lab values are notable for a hemoglobin of 7.9 mg/dL, albumin of 2.5 g/dL, sodium of 152 mEq/L, potassium of 2.1 mEq/L, chloride of 118 mEq/L. Vital signs are notable for a heart rate of 118 bpm, blood pressure of 86/38 mmHg, temperature of 102°F, and pulse oximetry of 85% on room air. The nurse advocates for which order?

Question

The 56-year-old intubated and sedated patient&rsquo;s arterial blood gas results are as follows: pH = 7.25, PCO2 = 36, PaO2 = 50, HCO3- = 15, SaO2 = 86%. Other lab values are notable for a hemoglobin of 7.9 mg/dL, albumin of 2.5 g/dL, sodium of 152 mEq/L, potassium of 2.1 mEq/L, chloride of 118 mEq/L. Vital signs are notable for a heart rate of 118 bpm, blood pressure of 86/38 mmHg, temperature of 102&deg;F, and pulse oximetry of 85% on room air. The nurse advocates for which order?

Accepted Answer

Transfuse 1 unit whole blood. The patient is profoundly hypotensive, which is likely contributing to the metabolic acidosis and caused by dehydration. The best action would be to transfuse the patient to simultaneously treat the anemia and dehydration. Once the patient is fluid resuscitated, if still hypotensive, norepinephrine can be titrated. The patient&rsquo;s sodium is elevated, so administering normal saline will worsen that; additionally, colloid fluid (like whole blood) is a better option than crystalloid fluid (normal saline) for fluid resuscitation as the higher oncotic pressure keeps the fluid in the vascular system rather than leaking out into the third space. The patient&rsquo;s carbon dioxide is on the low side of normal, so increasing the respiratory rate is not the most appropriate action.

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