A 14 month, male castrated Labrador Retriever is presented laterally recumbent and minimally responsive. He has been staying at a boarding facility for the last week and was noted to have picked up ‘the cough that is going around’ during his stay at the facility. The caretakers have noted him coughing for the last 2-3 days. Yesterday he did not eat all of his food, and this morning he was found in the cage laterally recumbent and unresponsive prompting immediate presentation to the emergency service.
At presentation the dog is laterally recumbent and responds only to noxious stimuli (including your attempts at intubation). He is cold to the touch, and femoral pulses are not palpable. The mucus membranes are cyanotic and he takes gasping inhalations approximately every 8-10 seconds. Within 3 minutes of hitting your STAT table the dog has 2 large-bore IV catheters, a fluid bolus is started, blood is collected with STAT labs running, he is intubated (with a small dose of fentanyl), manually ventilated with a bag-valve-mask on high-flow oxygen, and instrumented for monitoring.
T 97.1F P 90 R 6-8 mm cyanotic CRT >3s BCS 5/9 Weight 29kg BP – -/- – (- -mmHg) SpO2 76% (room air)
Interpret the blood gas:
Step 1: Evaluate the pH
The pH is very low at 7.03 – this is acidemia.
Step 2: Determine the primary process
Acidemia can be caused by a high pCO2 or a low bicarbonate. This patient has both a high pCO2 and a high bicarbonate – so this is a mixed acid-base disturbance.
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