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Our ABG Toxicology conundrum

31/3/2021

2 Comments

 
This is the first of 3 weeks of posts. We’d love readers to play along and post up some answer suggestions on our facebook page (https://www.facebook.com/fellowshipexam).
 
A patient presents semiconscious after an unknown overdose. His medical history indicates a history of epilepsy, but there is no medical record of his medications listed. Initial bloods in resus are taken:
 
Venous gas:
pH                               7.12
pCO2                          26        mmHg
HCO3-                        12        mmol/L
Na+                             140      mmol/L
Cl-                                104      mmol/L
 
Creatinine                  60        umol/L
Urea                            4          mmol/L
 
BSL                              5.5       mmol/L
Ketones                      Not detected.
 
Lactate                       10        mmol/L
​
We’ve thrown this out in this week’s 5 point fellowship Friday to emphasise a couple of really important points about understanding the exam.
 
Work through the ABG and calculate the acid base disturbances.
 
Then ask yourself:

 
1.What are the possible diagnoses?
2.Are there any further bloods you need to check?
3.Are there any other bedside tests you’d run?
4.Is there a rare antidote you might have to give this patient?
 
*Every piece of information you have been given is fair game for your analysis.*
 
Share your  thoughts on our facebook page at https://www.facebook.com/fellowshipexam.
If you want to read an ABG/VBG in 5 steps go to the RESUS Page
2 Comments
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    ShareThe Written Fellowship Course has its beginnings back in 2007, When Dr Kas started it at RPA in Sydney. It was then called the Kamikaze Course.
    Now we upgrade the experience so you can learn at your own pace.
    Your FACEMs leading the course are Dr Peter Kas and Dr Luke Lawton

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