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:
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