56 year old male presents to ED after taking an unknown quantity of perindapril/indapamide combination 6 hours previously.
He also has consumed alcohol. He was recently admitted to hospital for a similar presentation and was thought to have aspirated. He spent 2 days in hospital and was discharged with a Salbutamol MDI and Augmentin, and was told he had asthma.
The patient has a background history of hypertension for which he takes perindapril/indapamide (4mg/1.25mg). He also has a history of depression for which he is not on medication. He is a current smoker.
Initial examination –
HR 85 BP 100/70 Sats 91 % R/A RR 22 Apyrexial
GCS 15
Mild increased work of breathing, with generalised wheeze.
Initial VBG on arrival
pH7.39 Na 143mmol/l
pCO2 43mmHg K 3.5mmol/l
pO2 59mmHg Cl 106 mmol/l
HCO3 25mmol/l Cr 83umol/l
BE 1 Glucose 5.9
Lactate 3.8 mmol/l
The patient was treated with fluid boluses of normal saline for his BP and back to back salbutamol nebs. It was assumed that the patient might have aspirated again.
The patients BP fluctuated between 90 and 100mmHg systolic, but the patient maintained GCS15, and was producing around 50ml of urine per hour. He had some response to salbutamol nebs, therefore they were repeated.
5 hours post arrival a repeat gas was done:
pH 7.26 Na 143mmol/l
pCO2 29mmHg K 2.9mmol/l
HCO3 13mmol/l Cl 110mmol/l
B/E -13 Cr 131umol/l
Lactate 14
- Describe and interpret the second VBG
- What are the likely causes for the change in the VBG