Adam’s Hemoglobin Case Study

Read/review the following resources for this activity:

Textbook
Weekly Concepts
Minimum of 1 scholarly source
Scenario/Summary

cabin with mountains in the background. Adam and his family decided to take a trip to the mountains for the weekend in late February. They had a small cabin and looked forward to a weekend away from the big city. The family had a wonderful time together on Saturday morning hiking in the woods and enjoying nature. However, Saturday afternoon a storm rolled in bringing snow and subfreezing temperatures.

Since the heater in the cabin wasn’t working well, Adam’s mother and sister decided to drive into the nearest town to spend the night. Adam and his father, not being sissies, stayed at the cabin where they started a gas heater to keep them warm.

The next morning Adam’s mother and sister returned to find both Adam and his father unconscious. An ambulance was called and they were both transported to the nearest hospital. Adam had arterial blood gases drawn with the following results:

pH 7.2
PaCO2 31.4,
PaO2 40.7 mmHg
His oxygen saturation was 72%. Adam was diagnosed with carbon monoxide poisoning.

Deliverables

Answer the following questions and save your responses in a Microsoft Word document. Provide a scholarly resource to support your answers.

With respect to hemoglobin loading, please explain the relationship between binding of oxygen (O2) and carbon monoxide (CO) to the hemoglobin molecules.
During the ambulance ride, a pulse oximeter showed 100% O2 saturation. Why is that different from the 72% measured at the hospital?
One course of treatment is a hyperbaric oxygen treatment. How does a hyperbaric chamber work?
Adams blood work shows him to be in an acidosis (normal blood pH is 7.35-7.45). Explain how this will shift the hemoglobin dissociation curve and why.

ANSWER

Hemoglobin Case Study

With respect to hemoglobin loading, please explain the relationship between oxygen (O2) binding and carbon monoxide (CO) to the hemoglobin molecules.

Hemoglobin is often responsible for oxygen transportation in the human body. Usually, the oxygen concentration is high in an individual’s lungs, and it effortlessly combines with oxygen (Sarkar et al., 2017). When this process happens, there is the formation of oxyhemoglobin, the best form in the body that transports oxygen to the human tissues. In tissues with low oxygen concentration, oxyhemoglobin quickly disintegrates into oxygen and hemoglobin. Therefore, oxygen diffuses from the red blood cells through the capillary walls and into the human tissues. The hemoglobin then becomes free once more to collect more oxygen from the lungs, and the process repeats itself.

Carbon monoxide combines with hemoglobin to create carboxyhemoglobin. When compared to oxygen, hemoglobin has a greater affinity for CO. It is essential to note that they have a similar hemoglobin binding site for both oxygen and carbon monoxide. As a result, carbon monoxide creates a crucial competition for oxygen. When carbon monoxide and oxygen combine to form carboxyhemoglobin, the final product does not effectively dissolve; hence it reduces the hemoglobin capacity to transport oxygen all over the body tissues. When both oxygen and carbon monoxide are present, hemoglobin binds faster and more with carbon monoxide, which further causes breath shortness and, in some cases, death. This makes carbon monoxide a poison that can result in death if one inhales it for long.

During the ambulance ride, a pulse oximeter showed 100% O2 saturation. Why is that different from the 72% measured at the hospital?

A pulse oximeter is an instrument used to measure the oxygen concentration percentage in the human blood. The oximeter’s display shows the attention, and its sensor indicates the detected pulse. The present carbon monoxide in the blood shows a false oxygen concentration impression which, unfortunately, the pulse oximeter cannot see. When both carbon monoxide and oxygen are present, the hemoglobin binds faster with carbon monoxide, which denies oxygen the opportunity to bind with hemoglobin. The detected oxygen concentration is not accurate but merely an exaggeration. There was a higher concentration of carbon monoxide in the blood.

When they got to the hospital, the caregivers measured the oxygen concentration using the oxygen monitor. Unlike other devices, oxygen monitors are sensitive and accurate in detecting oxygen. At the same time, they alert physicians of any cases of oxygen levels dropping below the levels. The disparity existed because of carbon monoxide presence in Adam’s blood and the inability of the oximeter to detect the levels during the measurement that occurred during the ride.

One course of treatment is a hyperbaric oxygen treatment. How does a hyperbaric chamber work?

Hyperbaric oxygen treatment involves the use of a sliding bed. The patient lies on this bed before taking him to the special treatment section. A patient is often put into an airtight chamber to take intensive oxygen into their body. There is a gradual increase of pressure in the tubes during the process, and it goes above the normal atmospheric pressure. The air usually is 100% enriched with concentrated oxygen gas (Huang, 2015). According to the patient’s needs, the oxygen supply is adjusted to suit their requirements. When there is increased oxygen pressure and concentration in the patient, the patient’s lungs open up more, and they can then take in more oxygen amount. The oxygen amount may be higher than the usual uptake, and with the increment, there is faster facilitation of oxygen and hemoglobin binding. When this happens, the flow of oxygen in the body and lungs can happen once more. A technician can monitor this patient and can determine the session duration. The required oxygen determines the patient’s amount of time in one session.

Adams’s blood work shows him acidosis (normal blood pH is 7.35-7.45). Explain how this will shift the hemoglobin dissociation curve and why.

Acidosis is a condition where the human body fluid has excess acid. With this, the body fluid acquires a 7.35 or below pH level (Kraut & Madias, 2016). With the acid concentration increase, a hemoglobin dissociation curve shifts to the right. This shows that the hemoglobin’s affinity has reduced and can hardly combine with oxygen. It further disrupts the regular oxygen transportation to the tissues. It is also essential to note that an increase in the body fluid’s acid levels results in the catalysis of the already combined oxygen. When there is a decrease in the pH, the curve shifts right because of the H+ ions increment. The hemoglobin’s ability to integrate with the body’s oxygen reduces when the acidity levels go high.

References

Huang, E. T. (2015). A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers.

Kraut, J. A., & Madias, N. E. (2016). Lactic acidosis: current treatments and future directions. American Journal of Kidney Diseases, 68(3), 473-482. https://www.sciencedirect.com/science/article/abs/pii/S0272638616301688

Sarkar, M., Niranjan, N., & Banyal, P. K. (2017). Mechanisms of hypoxemia. Lung India: official organ of Indian Chest Society, 34(1), 47. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234199/

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