Chapter·SurgeryFluid and electrolyte management

Acid-base disorders in surgical patientsDownloads

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1

A 65-year-old man is brought to the emergency department from his home. He is unresponsive. His son requested a wellness check because he had not heard from his father in 2 weeks. He reports that his father was sounding depressed during a telephone call. The paramedics found a suicide note and a half-empty bottle of antifreeze near the patient. The medical history includes hypertension and hyperlipidemia. The vital signs include: blood pressure 120/80 mm Hg, respiratory rate 25/min, heart rate 95/min, and temperature 37.0°C (98.5°F). He is admitted to the hospital. What do you expect the blood gas analysis to show?

ANon-anion gap metabolic acidosis

BMetabolic alkalosis

CRespiratory acidosis

DAnion gap metabolic acidosis

EMixed acid-base disorder

2

A 24-year-old woman presents to the emergency department after she was found agitated and screaming for help in the middle of the street. She says she also has dizziness and tingling in the lips and hands. Her past medical history is relevant for general anxiety disorder, managed medically with paroxetine. At admission, her pulse is 125/min, respiratory rate is 25/min, and body temperature is 36.5°C (97.7°F). Physical examination is unremarkable. An arterial blood gas sample is taken. Which of the following results would you most likely expect to see in this patient?

ApH: increased, HCO3-: increased, Pco2: increased

BpH: decreased, HCO3-: decreased, Pco2: decreased

CpH: decreased, HCO3-: increased, Pco2: increased

DpH: increased, HCO3-: decreased, Pco2: decreased

EpH: normal, HCO3-: increased, Pco2: increased

3

A 27-year-old man presents to the emergency department with his family because of abdominal pain, excessive urination, and drowsiness since the day before. He has had type 1 diabetes mellitus for 2 years. He ran out of insulin 2 days ago. The vital signs at admission include: temperature 36.8°C (98.2°F), blood pressure 102/69 mm Hg, and pulse 121/min. On physical examination, he is lethargic and his breathing is rapid and deep. There is a mild generalized abdominal tenderness without rebound tenderness or guarding. His serum glucose is 480 mg/dL. Arterial blood gas of this patient will most likely show which of the following?

A↑ pH, ↑ bicarbonate, and normal pCO2

B↓ pH, ↓ bicarbonate and ↑ anion gap

C↑ pH, normal bicarbonate and ↓ pCO2

D↓ pH, ↓ bicarbonate and normal anion gap

E↓ pH, normal bicarbonate and ↑ pCO2

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