Lab Case 9

A 60 year old male is brought to your Emergency Department by ambulance. On scene he was found with a GCS 12 and a BSL of 2.

On route he received 50mls of 50% dextrose ivi. He was vomiting profusely.

The history obtained from family (by paramedics) was that the patient was on a three day alcohol bender, which was not unusual. He was not english speaking. There was a history of malaena and oesophageal varices in the past.

He complained of Thoracic back pain and weakness

On examination

Vitals: GCS 15                   BP 100/50             PR 120/min

T 35.8                     RR 18/min              O2 sats 99% RA

Describe and Interpret the following venous blood gas and results

pH 6.91                             COHb 0.9%                        Glu 6.0

pCO2 36                            MetHb 0.8%                       Lactate 25

pO2 47.2                           Na 147                                Hb 171

HCO3 7.2                          K 4.2                                   Urea 8.1

BE -24.5                            CL 102                                Creatinine 120

WCC 27.1                          N 17.0

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One thought on “Lab Case 9

  1. VBG interpretation:
    1) Acidaemia
    2) Lactate acidosis
    3) Severe metabolic acidosis – high anion gap
    4) Hypernatraemia
    5) Leukocytosis (with left shift)
    6) Elevated Hb
    7) Renal failure

    Clinical interpretation:
    Hypothermic, hypotensive, tachycardic, decreased GCS, vomiting, thoracic back pain, dehydration, hypoglycaemic initially
    Alcohol abuse, likely chronic hepatic failure with sequelae

    Overall differentials (limited list):
    1) High anion gap metabolic acidosis culprits: Methanol overdose, ethylene glycol, aspirin et al.
    2) Acute on chronic liver failure with alcohol ingestion (hyponatraemia would make a better case)
    3) Gastroenteritis/infectious cause – I’d love to explore the back pain further
    4) Many many more

    Cheers,
    SMW

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