Grave acidosis after severe anaphylactic bronchospasm: friend or foe?

Authors: Pytte; Opdahl¹; Skaga²

Source: Acta Anaesthesiologica Scandinavica, Volume 51, Number 4, April 2007 , pp. 495-500(6)

Publisher: Blackwell Publishing

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Abstract:

In a 20-year-old woman with known asthma, anaphylactic bronchospasm induced a grave combined respiratory and metabolic acidosis (pH_a 6.66) with marked hypoxaemia (S_aO₂ 45%). The beneficial effects of the rightward shift of the oxyhaemoglobin dissociation curve on tissue O₂ unloading at such pH was more than offset by the negative effect on S_aO₂ at the reduced P_aO₂ (7.0 kPa) found in this patient. This case illustrates the detrimental effect of grave acidosis on arterial blood oxygen content at subnormal P_aO₂ values, the beneficial effect of a supranormal P_aO₂ on the S_aO₂ in such patients, and the rapid remission rate of life-threatening acidosis and blood lactate after adequate ventilation and tissue oxygenation were secured. The initial treatment of the patient and clinically relevant considerations are discussed.

Keywords: Acidosis; adult; anaphylaxis; asthma; epinephrine; hypoxia

Document Type: Research article

DOI: 10.1111/j.1399-6576.2006.01223.x

Affiliations: 1: Department of Intensive Care, Ullevål University Hospital, Oslo, Norway 2: Department of Anaesthesiology

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