Case: 25 y/o male pt came to ER with altered mental status(AMS)-------
vitals: increased RR, PR and bp150/85
What test You should do in patient with AMS-----do basic metabolic panel(BMP), Urine analyis, Urine Drug screen, ABG.
Na- 139
K- 4
Cl- 102
hco3- 11
BUN 15
Cr 0.8
Glucose 110
ABG----------ph 7.19, Pco2- 24, po2- 95
Urine drug screen---negative
So this patient is having ph 7.19 which is less then 7.35 so patient is having acidosis----------HCO3( normal 22-26)---11 which is low-----------------so It is metabolic acidosis-----------
Expected decrease in PCO2= 1.2 x ( decrease in HCO3) = 1.2 x (24-11) = 1.2 x 13 = 16
this pt's PCO2= 24 -----and 40-16= 24------------so this is compensatory respi alkalosis.....
,
Next step is to calculate Anionic Gap= Na - ( HCO3- Cl) = 139- 113= 22
Normal AG = 3 to 12...
so this pt is hving AGmetabolic acisdosis
Causes of Met acidosis--------MUDPILES
this pt has normal S.cr so cant be uremia
normal glucose----so cant be DKA
So next step is t check serum Methanol, Ethanol, blood alcohol, lactic acid, salicylate level....
Blood alcohol , lactic acid and salicylate level normal and plasma osmolar gap is 25 ----so probably ethanol or methanol poisoning....
Management: check ABC, give fomipezol and hemodialysis( because of symptoms) and NaHCO3
vitals: increased RR, PR and bp150/85
What test You should do in patient with AMS-----do basic metabolic panel(BMP), Urine analyis, Urine Drug screen, ABG.
Na- 139
K- 4
Cl- 102
hco3- 11
BUN 15
Cr 0.8
Glucose 110
ABG----------ph 7.19, Pco2- 24, po2- 95
Urine drug screen---negative
So this patient is having ph 7.19 which is less then 7.35 so patient is having acidosis----------HCO3( normal 22-26)---11 which is low-----------------so It is metabolic acidosis-----------
Expected decrease in PCO2= 1.2 x ( decrease in HCO3) = 1.2 x (24-11) = 1.2 x 13 = 16
this pt's PCO2= 24 -----and 40-16= 24------------so this is compensatory respi alkalosis.....
,
Next step is to calculate Anionic Gap= Na - ( HCO3- Cl) = 139- 113= 22
Normal AG = 3 to 12...
so this pt is hving AGmetabolic acisdosis
Causes of Met acidosis--------MUDPILES
this pt has normal S.cr so cant be uremia
normal glucose----so cant be DKA
So next step is t check serum Methanol, Ethanol, blood alcohol, lactic acid, salicylate level....
Blood alcohol , lactic acid and salicylate level normal and plasma osmolar gap is 25 ----so probably ethanol or methanol poisoning....
Management: check ABC, give fomipezol and hemodialysis( because of symptoms) and NaHCO3
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