SAQ 1367 – Child with vomiting, lethargy and venous blood gas

A 4-year-old boy is brought to ED with 2 days of increasing vomiting and lethargy. His venous blood gas is shown.

Test	Result	Reference range
pH	7.18	7.35-7.45
pCO2	21 mmHg	35-45
pO2	25 mmHg	80-100
HCO3-	8 mmol/L	22-32
Base excess	-18.5 mmol/L	-3 to +3
Na	125 mmol/L	135-145
K	5.7 mmol/L	3.5-5.0
Cl	88 mmol/L	100-110
Glucose	38 mmol/L	3.0-7.8

Give the two most relevant acid-base findings and the formula used for each.

(Marked out of 4.0)
Conclusion | Formula<br /> 1 |<br /> 2 |

/ 4

State the underlying clinical condition.

(Marked out of 1.0)

/ 1

Briefly explain each of the listed abnormalities.

(Marked out of 3.0)
Abnormality | Explanation<br /> Low sodium |<br /> High potassium |<br /> Low chloride |

/ 3

List five other investigations you might perform and give the clinical indication for each.

(Marked out of 10.0)
Investigation | Clinical indication<br /> |<br /> |<br /> |<br /> |<br /> |

/ 10

State four specific elements of your fluid and electrolyte therapy.

(Marked out of 4.0)

Observation	Value
GCS	15
Pulse	180/min
Blood pressure	80/40 mmHg
Respiratory rate	35/min
Oxygen saturation	99% on room air
Temperature	36.5 degrees C
Perfusion	Poorly perfused

/ 4

State two other components of your management.

(Marked out of 2.0)

/ 2

Total Score: 0 / 24

Percentage: 0%