A 22 year old male is brought into ED after being found unresponsive on the street. On examination he smells strongly of alcohol, HR: 120 BP: 85/60 mmHg, RR = 11, SaO2: 90% on room air. An ABG is carried out and reveals the following:
pH = 7.50
PaO2 = 11 kPa
PaCO2 = 6.2 kPa
HCO3 = 30 mmol/L
Which type of acid-base abnormality does the ABG show?
Well done, correct.
Answer:
Step 1:The history suggests alcohol use and dehydration.
Step 2: PaO2 is normal.
Step 3: pH is higher than normal so the patient is alkalotic.
Step 4: PaCO2 is increased.
Step 5: HCO3 is increased.
Putting the information together and using the ROME mnemonic we come to the conclusion that this is a metabolic alkalosis with partial respiratory compensation. High levels of alcohol use may have led to vomiting leading to loss of stomach acids.
