SAQ 248 – Toxicology – methamphetamine toxicity and hyperkalaemia

A 26-year-old man is brought to the emergency department after stated deliberate self-poisoning. He was severely agitated at the scene and had a brief self-terminating seizure during transport. He remains agitated and restrained. BP is 200/110 mmHg, HR 140/min, RR 22/min, temperature 38.1 C, SpO2 98% on room air, and GCS 14. An arterial blood gas on room air is shown below.

Test	Result	Reference range
pH	7.25	7.35-7.45
pCO2	23 mmHg	35-45
pO2	99 mmHg	75-100
HCO3-	10 mmol/L	22-33
Lactate	5 mmol/L	0.7-2.5
Glucose	10 mmol/L	3.0-7.8
Base excess	-16 mmol/L	-3 to +3

Other than methamphetamine, list five (5) likely deliberate ingestions that may cause this presentation. Each must be from a different drug class.

(Marked out of 5.0)

/ 5

Provide one (1) calculation that assists interpretation of the blood gas.

(Marked out of 1.0)

/ 1

Using the scenario and calculated value, define the primary acid-base abnormality.

(Marked out of 2.0)

/ 2

Using the scenario and calculated value, define any secondary acid-base abnormality or compensation.

(Marked out of 2.0)

/ 2

After sedation, his CK is 80,000 U/L. He develops broad-complex bradycardia at 30/min with systolic BP 70 mmHg. Interpret this clinical state in five (5) points.

(Marked out of 5.0)

/ 5

List three (3) specific treatments to institute within the next 15 minutes.

(Marked out of 3.0)

/ 3

Total Score: 0 / 18

Percentage: 0%