Acid-Base



Acid-Base Lagniappe

(The first three should seem familiar and serve as a warm-up)

Assume all ABGs are on room air.

1. A 53 year-old woman complaining of palpitations and flushing followed by lightheadedness and tingling hands.

ABG: 7.56/20/65

142 | 110 | 15 / 105 Albumin: 4.0

4.5 | 20 | 0.9 \

What is her acid-base disturbance?

2. A 23 year-old man brought in by EMS after being found down.

ABG: 7.28/55/80 Albumin: 3.8

138 | 100 | 24 / 90

3.2 | 26 | 1.3\

What is the acid-base disturbance?

3. An 18 year-old non-compliant insulin dependent diabetic brought in with mental status changes.

ABG: 7.28/28/80 Albumin: 4.0

Serum Osms: 295

124 | 80 | 36 / 586 Urine Cl: 4

5.1 | 14 | 1.3\

What is the acid-base disturbance? Are there additional disturbances?

4. A 75 year-old woman with five days of profound diarrhea.

ABG: 7.30/30/83

146 | 119 | 46 / 101 Alb: 3.0

3.2 | 18 | 2.0\

What is the disturbance? Is there appropriate compensation?

5. An 18 year-old man with asthma.

ABG: 7.52/25/70

136 | 102 | 12 / 126 Alb: 4.0

3.9 | 22 | 0.9

What is the acid-base disturbance?

6. A 60 year-old woman with COPD presents complaining of cough and fever.

ABG: 7.32/60/65

140 | 100 | 14 / 101 Alb: 3.2

4.3 | 30 | 0.7

What is the disturbance? Compensation?

7. An 18 year-old high school student presents with nausea, vomiting, abdominal pain, mental status changes and difficulty seeing. He says it feels like he’s in a “snowstorm.”

ABG: 7.20/21/78

141 | 103 | 22 / 103 Alb: 4.0

5.0 | 9 | 1.2\ Serum Osms: 328

Blood Ethanol Content: 23 mg/dl

What is the disturbance? Are there additional Acid-Base disturbances? What did he ingest? What is the treatment?

8. A 78 year-old man with coronary artery disease presents with mental status changes.

ABG: 7.34/26/71

135 | 102 | 19 / 154 Alb: 3.0

4.3 | 19 | 1.1 Serum Osms: 290

What is the acid-base disturbance? What bottle of over-the-counter pills did he ingest?

9. A 42 year-old man with refractory hypertension presents with fatigue.

ABG: 7.56/45/70/32

146 | 102 | 15 / 252 Alb: 3.9

2.8 | 32 | 0.9\ Urine Cl: 30

What is the disturbance? What hormone(s) cause(s) this presentation?

10. A 55 year-old woman presents with weight loss, bone pain, and fatigue.

ABG: 7.41/41/82/24

138 | 114 | 25 / 95 Alb: 2.0

3.8 | 24 | 2.3\

What is going on in this scenario? What might be the underlying disease?

11. A 32 year-old man with acute renal failure.

ABG: 7.16/20/68 Alb: 3.9

Urine Na: 55

138 | 110 | 130 / 90 Urine K: 18

5.1 | 8 | 6.1 Urine Cl: 25

What is the primary acid-base disturbance? What is the secondary disturbance?

12. A 27 year-old man with a history of paranoid schizophrenia is admitted for mental status changes and lethargy, but no seizures. He has good skin turgor and no signs of peripheral edema. Below are his labs.

115 | 85 | 6 / 80 Alb: 4.0

3.2 | 18 | 0.5 Urine Osms: 75

Weight: 70 kg

What is causing this man’s hyponatremia? What is the treatment?

13. A 65 year-old man with a history of hypertension is admitted for mental status changes and lethargy, but no seizures. He has decreased skin turgor, dry mucosal membranes, dry skin, and is modestly hypotensive (100/60).

115 | 85 | 6 / 80 Alb: 4.0

3.2 | 18 | 0.5 Urine Osms: 700

Weight: 70 kg

What might be causing this man’s hyponatremia?

What is his sodium deficit?

How fast do you want to run your fluids to average 1 meq/hr increase in sodium?

14. An 85 year-old nursing home resident is found to be difficult to arouse. She is brought to the hospital for evaluation. She has decreased skin turgor, dry mucosal membranes, dry skin, and is hypotensive (95/65).

165 | 123 | 20 / 85 Alb: 4.0

4.1 | 30 | 1.0 Urine Osms: 750

Weight: 50 kg

What is this woman’s free water deficit?

How fast do you want to run fluids to correct her Na by 1 meq/hr?

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