SAQ 512 – Metabolic – severe hyponatraemia with seizure

A 59-year-old man with alcohol dependence is found confused after a generalised seizure that terminates with intramuscular midazolam. He is intubated for GCS 3. His venous blood gas and chemistry are shown below.

Test	Result
pH	7.19
PCO2	41.3 mmHg
HCO3	15.8 mmol/L
Base excess	-11
Sodium	105 mmol/L
Potassium	4.3 mmol/L
Chloride	77 mmol/L
Glucose	10.7 mmol/L
Lactate	6.0 mmol/L

State the acid-base abnormality.

(Marked out of 1.0)

/ 1

List three (3) differential diagnoses for this acid-base abnormality.

(Marked out of 3.0)

/ 3

List three (3) potential causes of the hyponatraemia.

(Marked out of 3.0)

/ 3

List five (5) investigations you would request and justify each.

(Marked out of 10.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Investigation</th> <th>Justification</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> <tr> <td>4.</td> <td></td> </tr> <tr> <td>5.</td> <td></td> </tr> </tbody> </table> <p>

/ 10

He has a further tonic-clonic seizure. List three (3) specific treatments and give doses.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Treatment</th> <th>Dose</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> </tbody> </table> <p>

/ 6

Total Score: 0 / 23

Percentage: 0%