Case of the Week: Acid-Base Disturbance #2

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Go to the profile of Julie Grishaw, ACNP
Apr 17, 2018
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A 66-year-old male with insulin-dependent diabetes mellitus, tobacco use, and COPD (FEV1 1.65 L, 50% predicted) presents to the emergency department with a 3-day history of diarrhea, fatigue, and lightheadedness. He recently returned from a cruise and both he and his wife are ill. He reports minimal oral intake over the past 2 to 3 days. His serum glucose is 160 mg/dL, and his urinalysis shows no ketones present. He has a baseline creatinine level of 1.0 mg/dL. He is hypotensive on presentation with a blood pressure of 80/50 mm Hg, heart rate 110 bpm.

Laboratory Data:

ABG

Basic Metabolic Panel

pH

7.22

Na

135 mEq/L

PaCO2

52 mm Hg

K

3.0 mEq/L

PaO2

80 mm Hg

Cl

102 mEq/L

HCO3

13 mEq/L

CO2

12 mEq/L

BUN

44 mg/dL

Cr

2.3 mg/dL

 

What is/are the primary acid-base disturbance(s) occurring in this case?

A - Metabolic acidosis only

B - Respiratory acidosis only

C - Metabolic acidosis and respiratory acidosis

D - Metabolic alkalosis and respiratory acidosis


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Go to the profile of Julie Grishaw, ACNP

Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education

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