A 70 year old man presents to ED with weakness, vomiting and central abdominal pain
Vital signs:
BP 140/90
PR 110/min
Temp 36 degrees
Blood tests:
pH 7.40 (7.3-7.44)
pCO2 56 (35-45 mmHg)
HCO3 34 (222-26 mmol/l)
BE 7
Sodium 135 (137-145 mmol/l)
Potassium 3.8 (3.5-5 mmol/l)
Chloride 90 (99-111 mmol/l)
Lactate 2.3 (<2 mmol/l)
Urea 11.6 (3-8 mmol/l)
Creat 125 (40-120 umol/l)
Bilirubin 23 (<21 umol/l)
GGT 117 (<51 U/L)
ALT 36 (<36 g/l)
ALP 61 (35-110 U/L)
Questions
- Describe and interpret 3 significant abnormalities in the blood gas
- List and interpret two other abnormailities
Metabolic alkalosis & hypochloremia 2o to vomiting
Respiratory acidosis, appropriately compensated (57 calculated)
Mild renal impairment, possibly prerenal 2o to dehydration (vomiting &tachycardic)
GGT ALP and bilirubin all slightly elevated. In elderly pt with vomiting & abdo pain, raises possibility of lesion obstructing cbd eg ca of pancreas /choledochocarcinoma; along with stone, need excluding with US.
Note also hyperlactaemia