SAQ 1149 – Overdose with high anion gap acidosis

A 23-year-old man presents to a rural ED after possible overdose and self-harm risk. His blood glucose is normal and the point-of-care venous blood gas is shown below.

Test	Result	Reference range
pH	7.34	7.35-7.45
Bicarbonate	16 mmol/L	22-28
Base excess	-6	-2 to 2
pO2	105 mmHg	80-110
pCO2	31 mmHg	36-45
Lactate	9.6 mmol/L	<2
Na	136 mmol/L	135-145
Cl	104 mmol/L	95-110
K	4.2 mmol/L	3.2-5.0

State two (2) primary acid-base abnormalities on this blood gas.

(Marked out of 2.0)

/ 2

State the calculation for the expected CO2.

(Marked out of 1.0)

/ 1

State the three (3) most likely causes of the abnormal results.

(Marked out of 3.0)

/ 3

There is concern about ethylene glycol ingestion. List two (2) blood gas features that are most specific for this toxic alcohol ingestion.

(Marked out of 2.0)

/ 2

List and justify four (4) important investigations in suspected ethylene glycol ingestion.

(Marked out of 8.0)
Investigation | Justification<br /> 1. |<br /> 2. |<br /> 3. |<br /> 4. |

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It emerges that he ingested a significant volume of ethylene glycol. List and justify three (3) immediate ED management priorities, including dose and route for medications or fluids.

(Marked out of 6.0)
Management | Justification<br /> 1. |<br /> 2. |<br /> 3. |

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Total Score: 0 / 22

Percentage: 0%