Case of the Month

Case of the Month # 5, Presentation

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It’s an eerily quiet morning in the ED when in comes a vomiting patient…

 

The (Made-Up) Case  48 year old M, pmhx DM, chronic/heavy drinker, presents with 4 days of NBNB vomiting. He hasn’t taken his diabetes medication during this time either. Denies abdominal surgeries, fevers, diarrhea, constipation, blood in the stool. ROS o/w neg.

VS 120, 130/70, 99.1 F orally, 20, 100% on RA. FS is 384

PE Dry MM, ill appearing.

Abdomen is soft, nondistended with mild epigastric tenderness. Exam is o/w benign.

 

You order him some IVF a GI cocktail and some basic labs.

 

His labs are as follows

VBG: pH 7.3, PO2 102, PCO2 30, HCO3 14, lactate 3

BMP:  Na 145, K 5.2, Cl 103, HCO3 15, BUN 10, Cr 0.5, gluc 301

Serum Osm: 298

Ketone: “unavailable due to manufacturer shortage”

Ua: mild ketones

 

Please describe:

(1) The acid-base derangement including the steps needed to determine it

(2) The diagnosis

(3) Treatment and dispo

 

By Dr. Andrew Grock

 

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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