Status Panicus

The other night we had a 36 year old woman come in for shortness of breath when I was about to leave my JPMC clinic. She had just had a typical fight with husband.. Of course I imagine there was quite a lot of drama as there tends to be with nearly any argument between partners.

However, in this case I was pretty impressed. Not with the details of the argument but with the numbers she was able to achieve (as we will see below). She came in breathing at about 50 times a minute! Her oxygenation was normal and her heart rate was slightly tachycardic. However, we decided to get some labs and do a CXR on her just to be safe (also I think to appease the parents a little). Her HCO3- (bicarb level) was pretty low (16) so we thought of acidosis. However, why would she be acidotic? Made no sense. So, we got an arterial blood gas. Would you believe her Ph was 7.71!!!!! (normal is 7.42) I have never seen such an alkalotic patient. Her bicarb repeated was 11 and her PCO2 was 14! She was hyperventilating so much that her body began to dump bicarbonate to try to bring the Ph back down! I can’t believe she did not pass out. We gave her 2 doses of ativan and told her to breath into a bag. When my shift was over, I signed her out still breathing about 30 into the bag! She needed more ativan I think!