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Metabolic acidosis

  I'm an RN and I have this patient who had pancreatitis due to gallstones. She had explo-lap /cholecystectomy a month ago and was intubated prior to surgery because of her acidosis. She was extubated 6 days post-op but got re-intubated 2 days after and has been trached already but still unable to be weaned off the vent. She has an ongoing problem with ileus, started her with tube-feeding with resultant diarrhea or high amount of residual in her ngt. She's 70 y/o with hx of same 8 yrs. ago treated with ERCP and has been dx with DM afterwards and sl. hypertension left untreated since pt. is afraid to go to doctors. This last 3 days, she has worsening metabolic acidosis, was brought back to OR today for exploration due to increasing abdominal distention  but no dead bowels were found, only inflammation and some redness in the bowels and pancreas. Still have high wbc,no bands. Of course, now she's got stool + vre. Can you please explain the ongoing metabolic acidosis and the ileus after all this time(1 month after original surg.) and treatment suggestions?
Dear Susan,
The metabolic acidosis in your patient may represent 1) hypoperfusion of tissues due to sepsis related to pancreatic inflammation, 2) hypoperfusion due to pancreatic necrosis, or 3) ketoacidosis due to the diabetes.  Failure to wean the patient from the ventilator suggests a component of repiratory insufficiency and possibly a respiratory acidosis.
This information is provided for educational purposes on;y.
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