An Interesting Acid/Base question

[tricophyton]

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If you want something to do to waste time before match day, consider this problem.....


What acid base abnormalitiy is exhibited by the following.

Consider a patient with:
pH 7.10
pCO2 50mmHg
Bicarb 15mmol/L
Sodium 145mmol/L
Chloride 100mmol/L

What are the acid/base disorders? (Hint: there is more than one)

If you are really good, give examples of medical conditions which would cause this. 🙂


I will give the answer after the weekend.

 

[ntmed]

pH 7.10
pCO2 50mmHg
Bicarb 15mmol/L
Sodium 145mmol/L
Chloride 100mmol/L

Anion Gap = 30
Delta/Delta= 2.22

Patient has a metabolic acidosis with anion gap.
The pCO2 is much higher than expected, so the pt also has a respiratory acidosis.
The Delta/Delta is also high, so the pt also has a metabolic alkalosis.

A mixed metabolic acidosis, metabolic alkalosis, and respiratory acidosis???

 

[tricophyton]

Anion Gap = 30
Delta/Delta= 2.22

Patient has a metabolic acidosis with anion gap.
The pCO2 is much higher than expected, so the pt also has a respiratory acidosis.
The Delta/Delta is also high, so the pt also has a metabolic alkalosis.

A mixed metabolic acidosis, metabolic alkalosis, and respiratory acidosis???

Good job,
Right on: Three primary disorders:
Respiratory Acidosis, Metabolic Acidosis and a Metabolic Alkalosis

an example of how this could happen is that the patient could present in an obtunded state (resp acid.), with a history of vomiting (met alk) and be in diabetic ketoacidosis (met acid).

Also, these lab finding can be present in a patient with chronic respiratory acidosis and metabolic compensation in whom an acute anion gap metabolic acidosis developed.

This is an impressive forum

 

[ntmed]

Good job,
Right on: Three primary disorders:
Respiratory Acidosis, Metabolic Acidosis and a Metabolic Alkalosis

an example of how this could happen is that the patient could present in an obtunded state (resp acid.), with a history of vomiting (met alk) and be in diabetic ketoacidosis (met acid).

Thanks for the example.

Have you (or anyone else) ever seen a patient with a mixed disorder like this? And if so, how did he/she present? Thanks.