Javaheri S, Nardell E A
Br Med J (Clin Res Ed). 1981 Oct 17;283(6298):1016-7. doi: 10.1136/bmj.283.6298.1016.
A 45-year-old man who was admitted with nausea, vomiting, and abdominal pain was found to have severe metabolic alkalosis, with a PaCO2 of 11.4kPa (85.5 mm Hg), PaO2 of 5.8 kPa (43.5 mm Hg), pH of 7.61, and plasma bicarbonate concentration of 82.0 mmol/l. He was treated with oxygen, intravenous physiological saline, and phenytoin and improved within 48 hours. Radiographs showed gastric outlet obstruction secondary to peptic ulcer, which was treated by surgery. Though sever, the rise in carbon dioxide concentration in this patient was probably lifesaving. The PaCO2 was therefore allowed to fall gradually as the alkalosis was treated. The return of both PaCO2 and plasma bicarbonate values to normal in parallel suggests that hypoventilation compensated for the metabolic alkalosis and emphasises the importance of conservative treatment in cases of metabolic alkalosis.
一名因恶心、呕吐和腹痛入院的45岁男性被发现患有严重代谢性碱中毒，动脉血二氧化碳分压（PaCO2）为11.4kPa（85.5mmHg），动脉血氧分压（PaO2）为5.8kPa（43.5mmHg），pH值为7.61，血浆碳酸氢盐浓度为82.0mmol/L。他接受了吸氧、静脉输注生理盐水和苯妥英钠治疗，并在48小时内有所好转。X线片显示为消化性溃疡继发胃出口梗阻，通过手术进行了治疗。尽管严重，但该患者二氧化碳浓度的升高可能挽救了生命。因此，随着碱中毒的治疗，允许PaCO2逐渐下降。PaCO2和血浆碳酸氢盐值同时恢复正常表明，通气不足代偿了代谢性碱中毒，并强调了代谢性碱中毒病例保守治疗的重要性。
