Lab Case 349

A 65 year old female is brought to ED via ambulance on a priority 1. According to the paramedics the patient has taken an overdose of benzodiazepines and alcohol. Her GCS is 3 and the team is preparing to intubate the patient. The following ECG is obtained prior to intubation:

pH 7.31                               Na 148 mmol/l

pCO2 16 mmHg                  K 1.2 mmol/l

pO2 46 mmHg                     Cl 136 mmol/l

HCO3 8.3 mmol/l                BSL 1.5 mmol/l

B/E -16.8                             Cr 17 umol/l

Lactate 0.3                           HB 46 mmol/l

  1. Describe and interpret the VBG
  2. What would be your next step in management of this patient?

One thought on “Lab Case 349

  1. Acidosis
    Primary metabolic acidosis as HCO3 is low (< 22) and CO2 is also low (<35) to compensate
    It is a NAGMA as AG < 16 (in fact it is low)
    Is there a concomittant respiratory component – expected CO2 = 24 (close enough) – there the patient is ventilating very well. Not fitting with benzo and EtOH ingestion
    Also note severe hypokalaemia and hypoglycaemia.
    This patient needs 50mL 50% dex and repeat BSL's along with potassium (at least 30mmol) and magnesium to assist in potassium uptake.

Comments are closed.