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