Access Medicine's Case of the Week: Acid Base Disturbance Case #10

From AccessMedicine

Like Comment


A 55-year-old woman with a history of adrenal insufficiency, hypothyroidism, and hypertension presents with altered mental status in the setting of a pneumonia. She has been hypotensive and tachycardic. She is intubated in the emergency department. Her initial blood pressure was 80/40 mm Hg, with a heart rate of 130 bpm and temperature of 39.00C. Her WBC is 18,000 with a 10% bands. She had a respiratory rate of 10 prior to intubation. Her TSH returns to normal. She reportedly hasn't been taking her medications for the last 3 days.

Laboratory Data:
ABG Basic Metabolic Panel
pH 7.10 Na 140 mEq/L
PaCO2 50 mm Hg K 5.6 mEq/L
PaO2 55 mm Hg Cl 110 mEq/L
HCO3 14 mEq/L CO2 13 mEq/L
BUN 24 mg/dL
Cr 2.0 mg/dL

Question 1 of 5

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 a respiratory acidosis

D - Metabolic alkalosis and a respiratory acidosis

Click HERE to view the case and answer all 5 progressive questions.

Don't forget to create a MyAccess profile to get the most out of your AccessMedicine subscription!

Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education