Alkalosis/ Acidosis

Case 1

23 yr old female presents with 2 day history of vomiting > 5 in number yellow in
colour, abdominal pain generalized, diarrhoeas x 2 no blood. Family also reported
fever and productive cough for the past week. The patient became confused within
the last 12 hours which prompted them bringing her to hospital.

Vitals BP 110/80 Pulse 100 RR 25 Spo2 99% on 2l oxygen RBS 457mg/dl

Mucus Pink and dry

Lungs: symmetric, decreased expansion to left base, egophony present, crackles to

left lung base

Abdomen: diffuse abdominal mild tenderness, no guarding no rebound, normal

bowel sounds

CNS GCS 10/15, no neurologic deficits

Labs:

Hb13 WBC 14,000 poly 85%

Bun 60 Cr 1.9

Na 136 K 6 Cl 101 Albumin 40

U/A Ketones 120mg/dl glucose + bact + nitrite negative protein 2+

ABG PH 7.26 Pco2 19 Hco3 7

What is your assessment and problem list for this patient?

Interpret the ABG

Case 2

21-year-old female presents with SOB according to her started hour ago after she
went to take exams, she felt overwhelmed and became unable to breathe. She feels
her throat has a lump

Patient is noted sitting in chair nervous, agitated, grasping her neck and breathing
rapidly and shallow.

Vitals RR 30 pulse 90 Bp 120/80 RBS 90 spo2 98%

Mucus: pink and moist

Lungs and thorax : symmetric good expansion, BAE clear

Rest of exam unremarkable

Labs

Hb 12 WBC 10 Plts 210,000 RFT/LFT are normal

CXR and ECG normal

ABG

PH 7.5 PCo2 28 HCO3 22 po2 98%

Interpret the ABG

What is the likely cause her ABG findings and list other possible causes
Case 3

75-year-old male with a history of COPD presents to the emergency room

complaining of worsening dyspnea and an increase in the frequency and purulence
of his sputum production over the past 2 days.

On examination vitals Bp 100/70 Sp02 78% on room air Pulse 120bpm

Mucus pink and moist

Lungs decreased breath sounds bilaterally with mild wheeze

Rest of exam is unremarkable

ABG is drawn

pH 7.25, PCO2 68, PO2 48, HCO3- 31

Interpret his ABG result

List all possible causes of his acid/base abnormality

Case 4

ABG (RA) 7.50 Hco3 49 Pao2 80 Pco2 36

Interpret the ABG above

List all possible causes

Case 5

A 68-year-old woman had a cardiopulmonary arrest immediately on returning

To the ward after a surgical procedure. The biochemical parameters are for ABG 5
minutes after

Ph 6.85 Pco2 82 po2 21 HCO3 14 lactate 12

Na 135 cl 97 k 3.45