SAQ 994 – Metabolic – vomiting with abnormal ECG and blood gas

A 40-year-old developmentally delayed patient is brought to your ED with vomiting.

She had a PEG inserted 4 weeks ago for feeding. On arrival her GCS is 13 (E4 V3 M6), which her carers say is normal for her. Observations are oxygen saturation 95%, RR 13, pulse 90 and BP 140/70. She weighs approximately 40 kg and takes no regular medications.

The ECG is shown below. Her clinical examination is unremarkable apart from dry mucous membranes. Bloods including a VBG are taken, and the ambulance crew have not placed an IV cannula.

Describe the ECG and provide three possible diagnoses.

(Marked out of 5.0)

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Describe and interpret the VBG, and provide a likely differential.

(Marked out of 5.0)

Parameter	Result	Reference range
pH	7.44	7.35-7.45
pCO2	47 mmHg	35-45
HCO3	42 mmol/L	22-28
BE	xxxx	-3 to +3
K	2.0 mmol/L	3.4-5
Na	155 mmol/L	134-146
Cl	129 mmol/L	98-106
Glu	7.4 mmol/L	3.5-5.5

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Outline your immediate management of this case.

(Marked out of 5.0)

/ 5

Total Score: 0 / 15

Percentage: 0%