Approach to acid-base disorders Quiz: Ace Your Exams

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A 25-year-old man with moderate persistent asthma presents to the emergency department with severe shortness of breath, wheezing and chest tightness. He is unable to provide much history due to confusion and lethargy. Temperature is 37.2 °C (99.0 °F), heart rate is 120/min, respiratory rate is 32/min, blood pressure is 135/85 mmHg, and oxygen saturation is 88% on room air. On examination, the patient is in distress and using accessory muscles for breathing. On auscultation there is bilateral expiratory wheezing and a prolonged expiratory phase. Arterial blood gas analysis is provided below. Which of the following is the best next step in management?

Test	Result
pH	7.28
PaO₂	45 mm Hg
PaCO₂	62 mm Hg
HCO₃-	24 mEq/L

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High-flow oxygen via nasal cannula

Inhaled fluticasone

Mechanical ventilation

Intravenous magnesium sulfate

Nebulized albuterol