A 50 year old with nausea, vomiting and backache Respiratory alkalosis
HCO3 of 22 which is consistent with an acute respiratory alkalosis
Symptoms don’t point to obvious cause but pain and hyperventilation must be considered
This patient came in as a priority 1 and was discharged 4 hours later with a diagnosis of Pyelonephritis.
Lactate is high – in the context of this presentation likely spurious/ insignificant.
Hmm, looked like there was more going on in that gas. Strong ion difference 34, BE +2, Lactate 4, corrected pCO2 35, not 24.
Mixed metabolic alkalosis and acidosis, maybe resp alkalosis primary.
Acute resp alkalosis -should- have a HCO3 of 20, not 22 (in ideal world).
Thoughts?
HI
Thanks for the comment
SID 38 (Na+K-Cl), normal 40, close enough to make no difference. If anything slighlty acidaemic which is in the right direction for a primary respiratory alkalosis/ elevated lactate.
Renal compensation takes a lot longer than respiratory compensation – may explain the HCO3
I don’t use Stewarts method:
-complex
-calculation of small differences between large numbers of variables -> decreases accuracy
-SID only reflect plasma (where as SBE reflects the whole body and Hb’s influence)
-lack of clinical correlation to validate benefit
-standard base excess accuracy has been well validated and accepted in clinical correlation