A 51-year-old man is admitted with an ischaemic left leg which is unviable and requires amputation. He becomes increasingly unwell while awaiting surgery, including experiencing episodes of difficulty breathing. An arterial blood gas (ABG) was taken.
pH 7.23, pO2 12.4, PCO2 ?, HCO3− ?, lactate 10.3 mmol/l.
What are the most likely PCO2 and HCO3−?
A 42-year-old man is in the Intensive Care Unit. He has an arterial blood gas that demonstrates pH 7.50, PaCO2 7.2 kPa, PaO2 10.2 kPa and HCO3− 36 mmol/l.
Which of the following is most likely to adjust the patient’s blood pH to normal range?
An 89-year-old patient presents to the Cardiology clinic. She has been seen previously for worsening congestive heart failure symptoms, but today she reports that her mobility and breathlessness have greatly improved, thanks to a new medication she has been prescribed. Routine blood tests report the following:
Investigation Result Normal value
Haemoglobin 122 g/l 115–155 g/l
White cell count (WCC) 4.7 × 109/l 4–11 × 109/l
Platelets 187 × 109/l 150–400 × 109/l
Sodium (Na+) 137 mmol/l 135–145 mmol/l
Potassium (K+) 2.7 mmol/l 3.5–5.0 mmol/l
Creatinine 115 μmol/l 50–120 µmol/l
What is the cause of her biochemical abnormality?
A senior citizen is referred to the Emergency Department by his General Practitioner, feeling generally unwell and with reduced urine output. Bloods tests show: Na+ 128 mmol/l, K+ 7.2 mmol/l, urea 42.6 mmol/l, creatinine 828 μmol/l.
An electrocardiogram (ECG) shows widespread tenting of T-waves.
Which of the following treatments should be given first?
A patient presents to the Emergency Department with palpitations and weakness. The senior doctor finds the arterial blood gas is as follows:
pH 7.5
pO2 12.6 kPa
pCO2 5.0 kPa
HCO3− 35 mmol/l
Which of the following could be the underlying cause?
A geriatric patient presents to the Emergency Department with a fast, irregular pulse, chest pain, weakness and palpitations. Upon arrival, investigations were carried out, including the following:
Investigation Result Normal value
PaO2 90 mmHg 75–100 mmHg
pH 7.35 7.35–7.45
PaCO2 27 mmHg 35–45 mmHg
Sodium (Na+) 125 mmol/l 135–145 mmol/l
Potassium (K+) 6.7 mmol/l 3.5–5.0 mmol/l
HCO3− 15 mmol/l 24–30 mmol/l
Chloride (Cl−) 107 mmol/l 98–106 mmol/l
Normal anion gap 10–18 mmol/l
With which of the following are the results consistent?
A 62-year-old man presents to his general practitioner (GP) for his routine diabetes assessment. He was diagnosed with type 2 diabetes one month ago. He also has a history of hypertension, obesity and hyperlipidaemia and smoking. He was recently commenced on metformin, ramipril, atorvastatin and aspirin. An electrocardiogram (ECG) is normal. The following laboratory results are obtained:
Investigation Result Normal value
Sodium (Na+) 136 mmol/l 135–145 mmol/l
Potassium (K+) 5.6 mmol/l 3.5–5.0 mmol/l
Glucose 8 mmol/l 3.5–5.5 mmol/l
Urea 5 mmol/l 2.5–6.5 mmol/l
Creatinine 78 μmol/l 50–120 μmol/l
What is the most appropriate management for this patient’s hyperkalaemia?
A 28-year-old woman is diagnosed with nephrotic syndrome secondary to focal segmental glomerulosclerosis after presenting with pedal oedema. She is being treated with furosemide 40 mg and prednisolone 60 mg. Her potassium level is 3.0 mEq/l (3.5–5.1).
Which of the following medications will not increase potassium levels?
A frail 82-year-old woman with metastatic renal cell carcinoma is admitted with acute confusion. She takes paracetamol and codeine for pain and has been on bendroflumethiazide for several years to treat hypertension. On examination, she is disorientated in time and place. She is clinically hypovolaemic but her blood pressure and heart rate are normal. Chest, cardiovascular, abdominal and neurological examinations are otherwise normal. There is no evidence of infection. Her blood results are as follows:
Creatinine 140 μmol/l
Urea 18.0 mmol/l
Sodium 129 mmol/l
Potassium 4.0 mmol/l
Corrected calcium 3.2 mmol/l
What is the most appropriate next step in management?
The arterial blood gas results show a pH of 7.2, p(O2) of 16.3 kPa, p(CO2) of 3.9 kPa, HCO3– of 16 mmol/l, and SaO2 of 94% on high-flow oxygen. Based on these results, which clinical scenario is most likely?