A -year-old woman with a history of type 1 diabetes mellitus presents to the hospital after days of worsening abdominal pain, severe nausea, and frequent episodes of nonbilious vomiting. She has missed several doses of her basal insulin due to her inability to tolerate oral intake. On arrival, her blood pressure is , and her pulse is . Physical examination reveals significantly dry mucous membranes, decreased skin turgor, and diffuse mild abdominal tenderness without rebound or guarding.
Laboratory values are as follows:
Serum sodium:
Serum potassium:
Serum chloride:
Serum bicarbonate:
Arterial pH:
Arterial :
Assume a normal baseline anion gap of .
What is the patient's calculated corrected bicarbonate level in ?
Cevap: 34 mEq/L
Cevap
The calculated corrected bicarbonate level is 34 mEq/L.
The correct calculation yields . A corrected bicarbonate value significantly higher than the normal range () indicates that a concurrent primary metabolic alkalosis is present. In this clinical scenario, the metabolic alkalosis is driven by the patient's intractable vomiting, which causes volume depletion and loss of hydrochloric acid, masking the absolute severity of the bicarbonate deficit caused by the diabetic ketoacidosis.
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Anahtar Kavram
Delta-delta calculation (corrected bicarbonate) to identify mixed acid-base disorders