A 22 year old female with severe hypochloraemic, hypokalaemic compensated metabolic alkalosis. She has moderate hyponatraemia, volume depletion (high Urea, lactate). There is also mild hypercalcaemia.
1. Medical – Hyperemesis Gravidarum, UTI, Hepatitis, Gastroenteritis,
2. Surgical – Peptic Ulcer disease, Appendicitis, Cholecystitis, torsion Ovarian cyst, Pancreatitis
3. Drug withdrawal
4. Other – DKA (glucose normal)
She requires resuscitation with normal saline, correction of hypokalaemia (add magnesium), Thiamine and Vit B6 (if hyperemesis), anti emetics, analgesia and treatment of underlying cause.
ph – 7.53, HCO 52, BE 26 => severe metabolic alkalosis
Expected CO2 = 0.7 X HCO3 + 20 = 56mmHg
Actual CO2 = 62 (venous sample) => adequate compensation
Anion gap = 6, low normal, however expect some acidosis (high lactate, possible ketoacidosis)
Osmolality = 274 – low, volume depletion from vomiting.
Calcium slightly elevated, concentration effect. (Hyperemesis is rarely associated with hyperPTH).