BIOCHEMICAL CASE 1

Patient’s sign and Symptoms

 Slight dyspnea (for 5 years and even when at rest)
 Difficulty in reclining – sitting up to sleep
 Has productive cough with yellowish- brown phlegm every morning
 BP 149/90 mmhg
 Heart rate of 96/minute
 Respiratory rate 2/minute
 Temperature 36.5C
 Has labored respirations and cyanotic lips
 Chest examination
o Bilateral wheezes
o Ronchi
o Anterioposterior diameter of the chest wall appears to be increased
o Inward movement of the lower rib cage with inspiration
 Cardiovascular examination findings
o Distant heart sounds
o Regular rate & Rhythm
o Normal Jugular Venous Pressure
 Extremities shows no cyanosis, edema or clubbing
MEDICAL TERMS:
 Dyspnea - difficult or labored breathing.
 Cyanotic - refers to a bluish cast to the skin and mucous membranes.
 Ronchi - are coarse rattling respiratory sounds, usually caused by secretions in bronchial airways
 Clubbing - also known as digital clubbing, is a deformity of the finger or toe nails associated with a number
of diseases, mostly of the heart and lungs.
DISCUSSION QUESTIONS:
1. What is the most common etiology of Chronic obstructive pulmonary disease (COPD)?
Smoking is the main cause of COPD. The more a person smokes, the more likely that person will develop
COPD. But some people smoke for years and never get COPD.
Characterized by expiratory airflow limitation that is not fully reversible (hallmark: airflow obstruction)
Unusual in the absence of smoking or prior history of smoking, except for patients with A1 –antitrypsin
deficiency

The pathological changes include

 Chronic inflammation
 Increased numbers of specific inflammatory cell types in different parts of the lungs
 Structural changes resulting from repeated injury and repair
Encompassed the following conditions
 Emphysema : anatomically-defined condition characterized by enlargement and destruction of
alveoli (PINK BUFFERS)
 Chronic bronchitis: Clinical Condition characterized by chronic cough and phlegm (BLUE BLOATERS)
 Small airways disease: condition where bronchioles are narrowed
MOST COMMON SYMPTOMS (CARDINAL SIGN)
Cough, sputum production, exertional dyspnea
2. What is the ACID-BASE ABNORMALITY of this patient?
The patient has increased alveolar-arterial tension gradient. In long standing disease such as this patient’s
condition, it may have chronically increased arterial pCO2 but metabolic compensation (increased HCO3)
maintains pH near normal.
 3. What is “partial pressure of dissolve gas”?

In the natural world, gases rarely exist in pure form and are most often observed as a mixtures of gases. The
concept of a "Partial Pressure" has been developed to quantify the concentration of a particular gas within a
mixture of gases. The Partial Pressure of any particular gas within a mixture is defined as the pressure that
the gas would exert in the absence of the other gases within the mixture. For example, atmospheric air is
composed of oxygen, carbon dioxide, nitrogen, and water vapor. The partial pressure of oxygen in
atmospheric air would be the pressure that the oxygen would exert if all of the other atmospheric gases were
removed

A corollary to this concept is that summation of all the partial pressures of the gases in a mixture should yield
the total pressure that the entire mixture exerts. Consequently, summing the individual partial pressures of
all the gases that compose atmospheric air should yield 760 mm Hg, equivalent to atmospheric pressure.

Partial Pressures of Nitrogen and Oxygen in Air

Dry air is made of 78% nitrogen (N2) and 21% oxygen (O2). The
partial pressures of these gases are simply the pressure they
would exert if they were isolated in the same volume of space.
Since atmospheric pressure is 760mm Hg, the 78% of
molecules contributed of nitrogen exerts roughly 600 mm Hg
of pressure while the 21% contributed by oxygen exert roughly
150 mm Hg of pressure.

4. Explain biochemically the pathogenesis of hypercapnia?

5. Explain biochemically how may the body compensate to the acid-base abnormality?