SAQ 247 – Cardiology and Renal – severe hyperkalaemia with mixed acidosis

Review Completed

Marked out of 17.00

A 64-year-old man presents with dyspnoea and palpitations. His history includes COPD, chronic renal failure, obesity, ischaemic heart disease, and hypertension. BP is 88/60 mmHg, RR 20/min, SpO2 88% on room air, GCS 15, and temperature 36 C. His ECG is shown below.

12-lead ECG for Geelong SAQ 027 question 9 — 12-lead ECG

State six (6) abnormal ECG findings.

(Marked out of 6.0)

/ 6

Using the venous blood gas shown, list three (3) key abnormalities and state one (1) point demonstrating the significance of each.

(Marked out of 6.0)

Test	Result	Reference range
pH	6.9	7.35-7.45
pCO2	60 mmHg	35-45
pO2	28 mmHg
HCO3	10 mmol/L	22-33
Base excess	-10	-3 to +3
K+	8.6 mmol/L	3.5-5.5

Blood-gas abnormality	Significance
1.
2.
3.

/ 6

List five (5) medications you may prescribe for this patient.

(Marked out of 5.0)

/ 5

Total Score: 0 / 17

Percentage: 0%

Abnormality	Significance
pH 6.9 with HCO3 10 mmol/L	Profound acidaemia with a major metabolic component, likely related to renal failure, and high morbidity and mortality.
pCO2 60 mmHg	Concurrent respiratory acidosis or type II respiratory failure, producing a mixed acidosis.
K+ 8.6 mmol/L	Severe life-threatening hyperkalaemia that may explain the ECG and requires immediate correction.

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