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Thread: [Acid-Base Disorders] 15-year-old boy

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    Default [Acid-Base Disorders] 15-year-old boy

    A 15-year-old boy with nephrotic syndrome presented with abdominal pain and vomiting. Lab data include: blood glucose 849 mg/deciliter, blood pH 7.19, PCO2 18 mm Hg, PO2 40 mm Hg, bicarbonate 7 mmol/liter, sodium 125 mmol/liter, potassium 6.2 mmol/liter, chloride 81 mmol/liter, and total carbon dioxide 8 mmol/liter. What is the best strategy to support this patient?
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

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    Default Re: [Acid-Base Disorders] 15-year-old boy

    1.pH 7.19 (decreased), PaCO2 18 mm Hg (decreased) so a primary metabolic acidosis.

    2.Expected PaCO2 = 40 - 1.2 x (24-7) = 19.6 > 18 mm Hg, so there is a secondary respiratory alkalosis.

    3.AG = 125 - (81 + 7) = 37 (increased)

    5.Gap-gap ratio = (37 - 12) / (24 - 7) = 1.47, so there is a DKA and I think there is also a lactic acidosis (look at the patient's PaO2, only 40 mm Hg).
    B.S. Pharm, West China School of Pharmacy, Class of 2007, Health System Pharmacist, RPh. Hematology, Infectious Disease. Chengdu, Sichuan, China.

    Blog: http://www.tomhsiung.com
    Facebook: http://www.facebook.com/TomHsiung
    Twitter: @TomHsiung
    Sina Microblog (Weibo): http://weibo.com/xiongliang0



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