Wednesday, November 19, 2014

Case: The patient underwent serum chemistry and arterial blood gas. Patient was found to have Na of 139 meq/l, K 3 meq/l, CL 93 meq/L and HCO3 of 35. Patient pH was 7.49 and pCO2 was 41. What is the underlying acid base disturbance.

A) Mixed Respiratory and Metabolic Alkalosis
B) Respiratory Alkalosis
C) Hyperchloremic non-anion gap metabolic acidosis  
D) Metabolic Alkalosis

Answer: D. Metabolic alkalosis

Rationale: Patient has pH of 7.49 suggestive of alkalosis. pCO2 is within normal range excluding respiratory alkalosis. The pH is high and chloride is 93 meq/L showing no indication of hyperchoremic metabolic acidosis. HCO3 is high and expected pCO2is within normal range (Expected CO2=0.9 x HCO3+9; .9X35+9=40.5) suggestive of simple compensated metabolic alkalosis as seen with diuretic therapy.

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