Septic shock and Metabolic Acidosis with respiratory alkalosis

Problem List:
Subjective (S):

.. 2553 HIV infection

2-3 2 /
GPO-VIR S(30) 1x2 q 12 hr, Fluconazole (200) 1x1 PC Co-Trimoxazole (80/400) 1x1 PC
Objective (O):
PR 120/min, RR 28/min, HR 115 bpm
Blood Chemistry
Test
Sodium
Potassium
Chloride
HCO3Total Protein
Albumin
Globulin
Total bilirubin
Direct bilirubin
Indirect
bilirubin
AST
ALT
ALP

Normal
136-145 mmol/L
3.5-5.1 mmol/L
98-107 mmol/L
22-29 mmol/L
6.4-8.2 g/dL
3.4-5 g/dL
1.5-3.5 g/dL

6/12/55
145
4.32
102.4
7.3
5.54
3.40
2.1
1.42
1.40
0.02

7/12/55
136
3.37
98.6
11.6
-

8/12/55
141
3.50
104.4
16.6
-

9/12/55
145
3.39
105.8
24.3
-

10/12/55
140
2.72
109.4
25.3
-

11/12/55
139
2.87
99.8
24.7
-

12/12/55
-

13/12/55
137
3.03
109.4
22.9
-

15-37 U/L
30-65 U/L
50-136 U/L

152
94
489

11/12/55
99 %
-

12/12/55
-

ABG
Test
SpO2
PaO2

Hematology

6/12/55 7/12/55 8/12/55 9/12/55

88 %
93 %
95-97 %
59 %
-

10/12/55
-

13/12/55
-

Test
Hb
Hct
HCV
RDW
WBC x103
Neut
Lymph
Mono
Eos
Baso
Platelet x103
RBC
Morphology
Reticulocyte
PT
PTT
INR
Other

Normal
12-16 g/dL
36-47 %
80-95 fL
12-14 %
4-10 /mm3
40-72 %
18-49 %
2-9 %
0-8 %
0-2 %
140-450 /mm3

Assesment (A):

7/12/55
-

8/12/55
-

9/12/55
9.5
27.8
76.0
16.0
10.80
80.6
10.0
7.1
1.9
0.4
292

10/12/55
-

11/12/55
9.4
27.7
76.7
16.3
10.42
73.8
7.1
10.4
8.5
0.2
268

12/12/55
10.8
31.7
76.4
17.1
12.9
76.4
6.6
9.9
6.9
0.2
339

13/12/55
9.6
28.5
77.2
17.3
11.96
73.3
7
12.8
6.7
0.2
282

Hypochromia 1+
Microcytosis Few
Polychromasia 1+

Hypochromia Few
Microcytosis Few
Polychromasia 1+

Hypochromia Few
Microcytosis 1+
Polychromasia 1+

Hypochromia 1+
Microcytosis 1+
Polychromasia 1+

Hypochromia 1+
Microcytosis 1+
Polychromasia 1+

9.5-13.5 secs 21.5-29.1 secs Ratio

-

Urinalysis
Date
Color
Turbidity
Sp.gr.
pH
Albumin
Glucose
Wbc/HPF
Rbc/HPF
Sq.epith/HPF
Blood
Ketone
Other

6/12/55
13.8
39.1
75.6
16.2
19.03
81.5
4.3
13.3
0.7
0.2
668

6/12/55
Deep yellow
Slightly clown
1.025
5.0
1+
Negative
1-2
0-1
0-1
Negative

PMN with
toxic granule

 white blood cell

HCO3- pH = 5.0
septic shock
septic shock Pharmacotherapy Handbook 7th ed

NSS, 50% Glucose 50 ml IV push

Metabolic Acidosis 7.5% NaHCO3
Pharmacotherapy
Handbook 7th edition
Plan (P):
Monitor
-

CBC
-
hypervolemia