Amazing

I am sometimes astounded by the human body. This year I have seen physiologic disturbances that I would have thought non-survivable, but patients somehow make a slow recovery. I suppose this is a way in which clinical experience teaches things that books simply cannot. My last call, my nineteenth admission (a personal record) was a patient who came in with a panoply of diagnoses. As we put the story together (which happened a day into admission as things were quite scattered when he first arrived), he was an alcoholic who developed pancreatitis from drinking too much. This lead to such severe vomiting that he tore part of his esophagus, leading to a gastrointestinal bleed. Either this GI bleed or his pancreatitis lead to a systemic infection of gut bacteria and an uncontrolled blood sugar to over 900. On arrival, his lactate, glucose, and liver enzymes were all higher than our lab's maximal levels. What I thought he was going to die from, though, was a severe acidemia. The body's normal pH is 7.4, and the body tightly regulates it because our proteins, enzymes, and metabolic processes only work in a narrow pH range. Even small pH changes of 0.05 from 7.4 are abnormal. When pH drops below 7.2, I start worrying that our blood pressure medications have limited effect because the receptors where they act become deformed. The highest pH I've seen was 7.7 (the cause was inexplicable). This patient had the lowest pH I've seen anyone survive - 6.7. The imminent cardiovascular collapse I expected never happened. With aggressive fluid resuscitation, antibiotics, insulin, and blood products, we got the pH closer to normal within hours and saved his life.