Grave acidosis after severe anaphylactic bronchospasm: friend or foe?

In a 20‐year‐old woman with known asthma, anaphylactic bronchospasm induced a grave combined respiratory and metabolic acidosis (pHa 6.66) with marked hypoxaemia (SaO2 45%). The beneficial effects of the rightward shift of the oxyhaemoglobin dissociation curve on tissue O2 unloading at such pH was m...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2007-04, Vol.51 (4), p.495-500
Main Authors: Pytte, M., Opdahl, H., Skaga, N. O.
Format: Article
Language:English
Subjects:
Acidosis
Acidosis - etiology
Adult
anaphylaxis
Anaphylaxis - blood
Anaphylaxis - complications
Anaphylaxis - therapy
Anesthesia
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Inflammatory Agents - administration & dosage
asthma
Asthma - complications
Asthma - therapy
Biological and medical sciences
Blood Gas Analysis - methods
Blood Glucose
Blood Pressure
Bronchial Spasm - blood
Bronchial Spasm - complications
Bronchial Spasm - therapy
Bronchodilator Agents - administration & dosage
Critical Care - methods
epinephrine
Female
Heart Rate
Histamine H2 Antagonists - administration & dosage
Humans
hypoxia
Hypoxia - etiology
Intubation, Intratracheal - methods
Lactic Acid - blood
Medical sciences
Nut Hypersensitivity - complications
Oxygen - administration & dosage
Oxygen - blood
Positive-Pressure Respiration - methods
Severity of Illness Index
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Summary:In a 20‐year‐old woman with known asthma, anaphylactic bronchospasm induced a grave combined respiratory and metabolic acidosis (pHa 6.66) with marked hypoxaemia (SaO2 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 SaO2 at the reduced PaO2 (7.0 kPa) found in this patient. This case illustrates the detrimental effect of grave acidosis on arterial blood oxygen content at subnormal PaO2 values, the beneficial effect of a supranormal PaO2 on the SaO2 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.
ISSN:0001-5172
1399-6576
DOI:10.1111/j.1399-6576.2006.01223.x