Lab Case 95 – see ECG of the week

A 44 year old man was found unconscious at home. He was brought in to the ED by ambulance. On arrival GCS =3 with fixed and dilated pupils. Temperature 25.9, hypotensive.Bloods show:

pH 6.9

pCO2  58  (35-45 mmHg)

HCO3  7  (22-26 mmol/l)

BE  -24

Sodium  132  (137-145  mmol/l)

Potassium  7.2  (3.5-5  mmol/l)

Cl  95  (99-111  mmol/l)

Urea  10.6  (3-8  mmol/l)

Creatinine  267  (<130  umol/l)

CK  1835

Lactate  26  (<2  mmol/l)

Bilirubin  71  (<21  umol/l)

ALP  152  (35-110  U/L)

GGT  88  (<51  U/L)

ALT  8791  (<56  U/L)

  1. Describe the abnormalities
  2. Interpret your findings and give reasonable differential diagnosis
  3. What are your immediate life threats?
  4. How would you proceed?



2 thoughts on “Lab Case 95 – see ECG of the week

  1. Just a CC paramedic here looking to practice with labs, so go easy on me! Patient is in an anion gap mixed acidosis, hyperkalemic, hypothermic and showing multi organ dysfunction.

    Given age, presentation and liver enzymes I am thinking OD. Maybe acetaminophen?

    Immediate life threats are acidosis, hyperkalemia, hypothermia.

    I would proceed with manual ventilation at RR of at least 30. Warm patient with warm saline, blankets and warmer if present. Treat the hyperK, CaCl, insulin, dextrose, bicarb, and ventolin. Assuming by this point our pH has come above 7.1 and his pressure is manageable. RSI and mechanical ventilation with the goal of maintaining a pH > 7.25 if possible. Call a Doc and see about acetylcystine?

    That’s where I run out of options and take him somewhere for further management.

    • Good effort – don’t have a lot more to add. I’ll post the answer later, please have a look. A few other causes to consider

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