F/38, history of Schizophrenia ,Drank a bottle (60ml) of Red Flower Oil

Repeated vomiting, denied any tinnitus

GCS 15, BP 159/90, P 83, Temp 37.2oC

SpO2 98% room air

Blood gas and electrolytes result in A&E

• pH 7.5, HCO3 20 mmol/l

• pCO2 26mmHg, PO2 250 mmHg
• Na 146 mmol/l, K 3.2 mmol/l, Cl 104 mmol/l
• Serum salicylate level = 6.19 mmol/l

What are the acid-base disturbances? Why?

Case 2:

Case 3:
Case 4:

Case 5:

An 18-year-old African-American male is brought to an urban emergency department by emergency medical services
after friends found him minimally responsive on the floor of his apartment. On arrival, his airway is patent, his
respirations are rapid and deep, and you note his

breath has a fruity odor. He is hemodynamically stable but somewhat tachycardic with slight decrease in pulse volume.
His initial chemistries are as follows: sodium 134 mmol/L, potassium 5.6 mmol/L, chloride 94 mmol/L, bicarbonate 10
mmol/L, and glucose 49.365 mmol/L.
His initial arterial blood gas measurements while receiving room air are as follows: pH 7.15, Paco2 14 mm Hg, Pao2 87
mm Hg, and bicarbonate 10 mmol/L.

Which of the following acid-base disturbances are present in this patient?

A. High-anion gap metabolic acidosis, normal-gap metabolic acidosis

B. Normal-gap metabolic acidosis, respiratory alkalosis

C. High-anion gap metabolic acidosis, respiratory alkalosis

D. High-anion gap metabolic acidosis, normal-gap metabolic acidosis, respiratory alkalosis

E. High-anion gap metabolic acidosis, metabolic alkalosis, respiratory alkalosis

Case 6:

All of the following may be responsible for the presence of a high-anion gap metabolic acidosis

except which of the following?

A. Diabetic ketoacidosis

B. Salicylate intoxication

C. Mild-to-moderate renal failure

D. Methanol ingestion

E. D-lactic acidosis

Case 7:

The patient is administered insulin and IV fluids. Four hours after initiation of treatment, 4 L of 0.9% NaCl solution has
been administered. The following laboratory values are obtained:

sodium 150 mmol/L, potassium 3.8 mmol/L, chloride 124 mmol/L, bicarbonate 13 mmol/L, and glucose 17.2 mmol/L.

His initial arterial blood gas measurements while receiving room air are as follows: pH 7.31, Paco2 26 mm Hg, Pao2 91
mm Hg, and bicarbonate 13 mmol/L.

Which of the following acid-base disturbances are now present in this patient?

A. Normal-gap metabolic acidosis

B. Normal-gap metabolic acidosis, respiratory alkalosis

C. High-anion gap metabolic acidosis, respiratory alkalosis

D. Normal-gap metabolic acidosis, respiratory acidosis

E. Respiratory alkalosis

Case 8:

An 78-year-old African-American male is brought to an urban emergency department by emergency medical services
after friends found him minimally responsive on the floor of his apartment. On arrival, his airway is patent, his
respirations are rapid and deep, and you note his breath has a fruity odor. He is hemodynamically stable but somewhat
tachycardic, with slight

decrease in pulse volume. In addition, you are told the patient is a smoker who is noncompliant with his “puffers.”

The following laboratory values are obtained: sodium 130 mmol/L, potassium 3.8 mmol/L, chloride 92 mmol/L,
bicarbonate 6 mmol/L, and glucose 17.2 mmol/L.

His initial arterial blood gas measurements while receiving room air are as follows: pH 6.95,Paco2 28 mm Hg, Pao2 70
mm Hg, and bicarbonate 6 mmol/L.

Which of the following acid-base disturbances is now present in this patient?

A. High-anion gap metabolic acidosis

B. High-anion gap metabolic acidosis, normal-gap metabolic acidosis, respiratory alkalosis

C. High-anion gap metabolic acidosis, respiratory alkalosis

D. High-anion gap metabolic acidosis, respiratory acidosis

E. High-anion gap metabolic acidosis, normal-gap metabolic acidosis, respiratory acidosis

Case 9:

A 19-year-old female college student is brought to the emergency department by friends who state that she has fainted
several times today when attempting to stand from a lying or seated position. She denies nausea, emesis, or diarrhea.
She admits that she “watches” what she eats.She denies taking any prescription or over-the-counter medications. Her
initial vitals show a

resting heart rate of 92 beats/min with a blood pressure of 98/52 mm Hg while in the supine position. When she
assumes a seated position with her legs off the edge of the bed, she becomes“light-headed.” The heart rate and blood
pressure are now 112 beats/min and 75/38 mm Hg,respectively.

Her initial chemistries are as follows: sodium 140 mmol/L, potassium 3 mmol/L, chloride 90 mol/L, bicarbonate 34
mmol/L, glucose 6.38 mmol/L, blood urea nitrogen 8.925 mmol/L, and creatinine 61.88 µmol/L.

Her initial arterial blood gas measurements while receiving room air are as follows: pH 7.48, Paco2 47 mm Hg, and
bicarbonate 34 mmol/L.

Which of the following acid-base disturbances are now present in this patient?

A. Normal-gap metabolic acidosis

B. Metabolic alkalosis

C. High-anion gap metabolic acidosis, respiratory alkalosis

D. Metabolic alkalosis, respiratory acidosis

E. Respiratory acidosis

Case 10:

A 76-year-old man with mild congestive heart failure and chronic obstructive pulmonary disease is admitted to the
hospital with recurrent pneumonia. He requires intubation for 2 days. After extubation, the patient is treated with
ceftriaxone and enalapril. Five days later, when he is awake, alert, and ambulating, the following laboratory values are
obtained: sodium 129

mmol/L, potassium 3.2 mmol/L, chloride 81 mmol/L, bicarbonate 38 mmol/L, glucose 5.994 mmol/L, blood urea
nitrogen 7.497 mmol/L, and creatinine 159.12 µmol/L. His initial arterial blood gas measurements while receiving room
air are as follows: pH 7.51, Paco2 49 mm Hg, Pao2 68 mm Hg, and bicarbonate 38 mmol/L.

Which of the following acid-base disturbances are present in this patient?

A. Normal-gap metabolic acidosis

B. Metabolic alkalosis

C. High-anion gap metabolic acidosis, respiratory acidosis

D. Metabolic alkalosis, respiratory acidosis

E. Respiratory acidosis

Case 11:

A 75-year-old man presents with confusion and anxiety. He lives alone. The emergency medical services personnel tell
you that his neighbors say he is healthy except for generalized arthritis. Several over-the-counter medications were
found at the scene, including aspirin and acetaminophen. He is tachypneic and mildly tachycardic but otherwise stable.

The following laboratory values are obtained: sodium 144 mmol/L, potassium 3.2 mmol/L, chloride 105 mmol/L,
bicarbonate 22 mmol/L, glucose 4.7175 mmol/L, blood urea nitrogen

His initial arterial blood gas measurements while receiving room air are as follows: pH 7.48, Paco2 30 mm Hg, Pao2 73
mm Hg, and bicarbonate 22 mmol/L.

Which of the following acid-base disturbances are present in this patient?

A. Normal-gap metabolic acidosis, metabolic alkalosis

B. Respiratory alkalosis

C. High-anion gap metabolic acidosis, respiratory alkalosis

D. Metabolic alkalosis, respiratory acidosis

E. High-anion gap metabolic acidosis, normal-gap metabolic acidosis, respiratory alkalosis

Case 12:

A 52-year-old male was admitted 5 days ago with a massive pulmonary embolus. He initially required mechanical
ventilation for hypoxemia but was hemodynamicaly stable and did not require vasopressor support. He is now
extubated but still complains of some shortness of breath. His oxygen saturation while receving 2 L/min of O2 is 98%.
His repeat computed

tomography angiogram of the chest shows no new thrombus, and the right ventricle appears normal in size at the
midmitral valve level. He is hemodynamically stable.

The following laboratory values are obtained: sodium 139 mmol/L, potassium 5 mmol/L,chloride 115 mmol/L,
bicarbonate 12 mmol/L, blood urea nitrogen 3.57 mmol/L, and creatinine 106.08 µmol/L.
His arterial blood gas measurements while receiving 2 L/min of O2 are as follows: pH 7.24,Paco2 28 mm Hg, Pao2 90
mm Hg, and bicarbonate 12 mmol/L.

Which of the following acid-base disturbances are present in this patient?

A. Normal-gap metabolic acidosis

B. Respiratory alkalosis

C. Normal-gap metabolic acidosis, respiratory alkalosis

D. High-anion gap metabolic acidosis, respiratory alkalosis