ICU SAQs · Acid–base
A systematic interpretation of a mixed blood gas
A classic CICM data-interpretation question testing the systematic method end to end — pH, primary disorder, Winter's-formula compensation (revealing a concurrent respiratory acidosis), the albumin-corrected anion gap, the delta-delta, and the lactate — before the management of septic lactic acidosis.
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Prompt
A 54-year-old man with urosepsis has the following arterial blood gas on 6 L/min oxygen: pH 7.20, PaCO2 28 mmHg, PaO2 64 mmHg, HCO3 11 mmol/L, base excess −16. Sodium 140, chloride 105, potassium 5.1, albumin 30 g/L, lactate 6.5 mmol/L, glucose 8.0. Interpret the acid–base disorder in full and outline the immediate management.
Question
A 54-year-old man with urosepsis has the following arterial blood gas on 6 L/min oxygen: pH 7.20, PaCO2 28 mmHg, PaO2 64 mmHg, HCO3 11 mmol/L, base excess −16. Sodium 140, chloride 105, potassium 5.1, albumin 30 g/L, lactate 6.5 mmol/L, glucose 8.0. Interpret the acid–base disorder in full and outline the immediate management.
[1]References4ShowHide
- [1]Adrogué HJ, Madias NE. Management of life-threatening acid-base disorders. First of two parts. New England Journal of Medicine, 1998.PMID 9414329
- [2]Kraut JA, Madias NE. Serum Anion Gap: Its Uses and Limitations in Clinical Medicine. Clinical Journal of the American Society of Nephrology, 2007.PMID 17699401
- [3]Kraut JA, Madias NE. Lactic acidosis. New England Journal of Medicine, 2014.PMID 25494270
- [4]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.