Shrestha, AshishGurung, NareshKarthak, AshishBhattarai, SanjeetLama, RakeshShrestha, Utsav KumarKhanal, KishorGhimire, AnupRegmi, AshimShrestha, Sanjeet Krishna2026-02-032026-02-032022https://hdl.handle.net/20.500.14572/4474Ashish Shrestha Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital Naresh Gurung Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital Ashish Karthak Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital Sanjeet Bhattarai Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital Rakesh Lama Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital Utsav Kumar Shrestha Department of pulmonary, critical care and sleep medicine, Nepal Mediciti Hospital Kishor Khanal Department of critical care, Nepal Mediciti Hospital Anup Ghimire Department of critical care, Nepal Mediciti Hospital Ashim Regmi Department of critical care, Nepal Mediciti Hospital Sanjeet Krishna Shrestha Department of pulmonary, critical care and sleep medicine, Nepal Mediciti HospitalAbstract: Chronic Obstructive Pulmonary Disease (COPD) patients generally present with respiratory acidosis and type 2 respiratory failure. Here we present a case of 65 years old female, who is a known case of COPD and presented in our emergency department with severe metabolic alkalosis (pH 7.730, HCO3- greater than 99.9mmol/l). She was referred from other center after the development of seizure. Urinary sodium was sent which indicated the cause of metabolic alkalosis was contraction alkalosis; we then treated the patient with IV fluids, antibiotics and Mechanical Ventilator. Arterial Blood gas analysis was initially done every 4 hours till the pH was corrected. After pH was corrected the patient was extubated to intermitted Non Invasive Ventilation (NIV) for type 2 respiratory failure. With pulmonary rehabilitation we could discharge the patient with inhalers; without the need for NIV or supplementary oxygen. This is one of the rare cases where the patient presented with a very high bicarbonate level, high partial pressure of carbon dioxide in arterial blood, and high pH. The patient was successfully managed with IV fluids and mechanical ventilation.en-USChronic Obstructive Pulmonary DiseaseRespiratory FailureNon Invasive ventilationMetabolic AlkalosisArticle