SAQ 1673 – Abdominal pain and vomiting with venous blood gas

A 27-year-old man is brought to the ED with abdominal pain and vomiting. His venous blood gas is shown below.

Venous blood gas	Result	Reference range
pH	7.41	7.35-7.45
pCO2	35 mmHg	35-45 mmHg
HCO3	22 mmol/L	22-32 mmol/L
Na	133 mmol/L	135-145 mmol/L
K	5.3 mmol/L	3.5-5.1 mmol/L
Cl	82 mmol/L	100-110 mmol/L
Lactate	4.6 mmol/L	0.5-2.2 mmol/L
Glucose	61.4 mmol/L	3.0-7.8 mmol/L

List the two most significant metabolic processes present. For each, provide relevant calculations and an explanation of the likely cause.

(Marked out of 6.0)

/ 6

List and justify four further investigations you would perform.

(Marked out of 4.0)

/ 4

The patient's vital signs are shown below. State five therapeutic interventions you would anticipate using in the first six hours, including endpoints where appropriate.

(Marked out of 5.0)

Vital sign	Result
GCS	13 (E3 V4 M6)
Pulse	135/min
BP	80/40 mmHg
Temperature	36.5 degrees C
Respiratory rate	24/min
Oxygen saturation	98% on room air

/ 5

Total Score: 0 / 15

Percentage: 0%