Lowest pH in viable patient

[DogFaceMedic]

What is the lowest pH some of you have seen in a patient that actually had a chance of survival? I've heard urban legends, but personally have not seen anything below 7. (I couldn't find the old hall of fame thread.)

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[GeneralVeers]

What is the lowest pH some of you have seen in a patient that actually had a chance of survival? I've heard urban legends, but personally have not seen anything below 7. (I couldn't find the old hall of fame thread.)

I've had some DKAers who were around 6.9 and lived. I'm constantly amazed at the horrendous acuity that some of these people can survive.

 

[FoughtFyr]

My personal low pH patient was 6.7 (hypothermic, walked out of hospital neuro intact 4 days after presentation). DropkickMurphy claimed a 6.0 on the old "Hall of Fame" thread.

- H

 

[mikecwru]

What is the lowest pH some of you have seen in a patient that actually had a chance of survival? I've heard urban legends, but personally have not seen anything below 7. (I couldn't find the old hall of fame thread.)

You'll often see PHs of 6.9 in patients that have seized, but end up doing well because the seizure causes a profound lactic acidosis. These are also the people where you'll get lactates of 14 and they'll turn out to be fine.

mike

 

[waterski232002]

6.81, Peds w/ Status Asthmaticus, intubated on the vent, survived. For some reason, peds can tolerate a much greater level of acidosis.

 

[DropkickMurphy]

DropkickMurphy claimed a 6.0 on the old "Hall of Fame" thread.

Yes, but that patient did not survive. The lowest I recall surviving was 6.87.

 

[The White Coat Investor]

6.96 is my best this week.

 

[augmel]

I had a 19 y/o non-compliant diabetic who had a pH of 6.9 and said she felt fine, didn't know what the fuss was about. I walked into the room and thought "so THAT's what kussmaul respirations look like." She left the unit the next morning after some bicarb and super aggressive fluid resuscitation. I had an asplenic lady get pneumococcal sepsis and survive a lactate of 19.

 

[debvz]

6.8 -
Showed up in the ED to be seen for some non-healing leg ulcers, and wound up coding in the ED. Initial Na was 110's, HCO3 of 5, and K >8. As the surg resident on call that night, I was paged by medicine to put in an "emergent shiley". After about a week of dialysis, prolonged pressors, a stroke, and multiple debridements of her legs, she's very much alive. Last I heard, she was transferred out of the ICU.