Case of the Week: Acid-Base Disturbance #5

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Go to the profile of Julie Grishaw, ACNP
May 08, 2018
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Clinical Scenario

A 65-year-old successful businessman with hypertension is brought to the emergency department from home with hypotension and shortness of breath. He recently traveled back from Asia following a business trip. Since returning home, he's noted some lightheadedness and dyspnea with exertion, which has significantly progressed over the last 12 hours. His blood pressure on arrival is 90/50 mm Hg with a heart rate of 120 bpm. He takes amlodipine and hydrochlorothiazide (HCTZ) for his hypertension and maintains a 2-gram salt diet. His baseline creatinine is 0.8 mg/dL.

Laboratory Data:

ABG

Basic Metabolic Panel

pH

7.50

Na

144 mEq/L

PaCO2

22 mm Hg

K

4.0 mEq/L

PaO2

214 mm Hg

Cl

98 mEq/L

HCO3

18 mEq/L

CO2

17 mEq/L

FIO2

0.60

BUN

44 mg/dL

Cr

1.9 mg/dL

Question 1 of 6

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

A - Metabolic acidosis only

B - Respiratory alkalosis only

C - Metabolic acidosis and a respiratory acidosis

D - Metabolic alkalosis and a 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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