55 year old female with alcohol intoxication
altered mental state – alcohol, other
risk of seizures
chronic alcohol abuse – liver disease, GI bleed, cerebellar disease, haematologic abnormlities
Severe metabolic alkalosis – pH 7.65, HCO3 54, BE 30
Compensation: expected CO2 = 0.7XHCO3 + 20 = 57.8
actual CO2 = 49 – reasonable early compensation, will be limited by central response
LFT – high bilirubin, GGT, ALT – chronic alcoholic liver disease, consider acute hepatitis
significant hypoNa, hypoK, hypoCL – classically occurs in loss of stomach fluids – eg. vomiting
high Urea, normal Creatinine – pre renal from vomiting and dehydration, consider GI bleed
FBC – essentially normal but consistent with chronic alcohol abuse
Lactate high – volume depletion
Anion gap = 4 – low normal
Osmolality 247 – very low
55 year old female with sever hypoCl, hypoK, metabolic alkalosis. This occurs with gastric outlet obstruction, however severe vomiting may account for this. Requires K replacement.
Severe hypo osmolar hypoNa with elevated urea – large volume loss and fluid shifts will account for this, secondary to vomiting. Must exclude GI bleed ie. secondary to peptic ulcer disease. Close monitoring for seizures. Cosiderations in volume replacement – CPM.
Consider chronic peptic ulcer disease and gastric outlet obstruction in this patient.
Other causes of metabolic alkalosis:
Endocrine – Conn’s, Cushing’s
Renal tubular acidosis
Excess HCO3 ingestion – antacid use/ abuse
Diuretic abuse/ use