AccessMedicine's Case of the Week: Acid-Base Disturbances: Clinical Scenario #32

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A 44-year-old male with alcoholism and a history of IV drug abuse presents with encephalopathy from home. He has been taking over-the-counter anti-inflammatory medications for a pinched nerve over the last few days. His vitals are blood pressure 100/60 mm Hg, heart rate of 123 bpm, temperature 102.4°F, respiratory rate 28 breaths/minute, saturation 95% on room air. He takes spironolactone, furosemide, propranolol, and rifaximin at home. A CT scan of the head is negative. LP puncture is also negative.

Laboratory Data:

ABG

Basic Metabolic Panel

pH

7.22

Na

131 mEq/L

PaCO2

20 mm Hg

K

5.5 mEq/L

PaO2

100 mm Hg

Cl

112 mEq/L

HCO3

8 mEq/L

HO2

8 mEq/L

BUN

29 mg/dL

Cr

2.3 mg/dL

Glucose

89 mg/dL

Albumin

1.5 g/dL

EtOH

0 mg/dL

 

Question 1 of 7: 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 alkalosis

E - Metabolic alkalosis

F - Respiratory alkalosis

Click HERE to answer the questions and complete the case!

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education