An 18 year-old 65 kg male with sickle cell anemia is involved in a motor vehicle accident sustaining a mandibular fracture.

He is admitted to the hospital and goes to the operating room 10 hours after admission. On admission the patient is started on 0.9% NS with 20 mEq potassium at 110 mL/hr. The patient’s HCT is 30% at the start of surgery. During surgery blood loss is approximately 75 cc. The patient receives 500 cc of Lactated Ringer’s solution intraoperatively. On arrival to the PACU the patient is shivering and complaining of feeling cold with a body temperature of (96F). Demerol (maperidine) 25 mg IV is administered for the shivering. Shortly thereafter the patient complains of dyspnea and extremity pain. Respiratory rate is 20. An ABG is taken and the results are pH 7.38, PaO2 of 80, PaCO2 of 42, and a bicarbonate of 22. What factor could be contributory to the patient’s presentation? A. Hypothermia B. Dehydration C. Anemia D. Demerol

Answer:

A. Hypothermia

Hypothermia may cause peripheral
vasoconstriction promoting vascular stasis and hyperthermia accelerates hemoglobin S
polymerization.

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