Lab Case 88 – Interpretation

70 year old female presents critically unwell following collapse with altered mental state.

  1. Abnormalities:

Severe respiratory acidosis

Additional metabolic acidosis – NAGMA, with high chloride (BE -10, expected HCO3 is 33 if acute respiratory acidosis)

Elevated Lactate


Typre II respiraory failure

Severe hypoperfusion with elevated lactate, is AG normal because of Saline administration?

Has this patient had a cardiac arrest to account for this presentation, what is the cause?


Intubate, hyperventilate

Maintain blood pressure/ ?inotropes

Look for cause


ICU admisiion


Interestingly, this patient made a full neurologic recovery and was discharged home 2 weeks later. The cause was thought to be primary respiratory arrest, from respiratory failure.