med 610 clinical respiratory diseases & critcare med

Arterial Blood Gas

Case 3

A 65 year-old man is brought into the VA hospital with complaints of severe nausea and weakness. He has had problems with peptic ulcer disease in the past and has been having similar pain for the past two weeks. Rather than see a physician about this, he opted to deal with the problem on his own and, over the past week, has been drinking significant quantities of milk and consuming large quantities of TUMS (calcium carbonate). On his initial laboratory studies, he is found to have a calcium level of 11.5 mg/dL, a creatinine of 1.4 and bicarbonate of 35. The resident working in the ER decides to draw a room air blood gas that reveals:

  • pH 7.45
  • PCO2 49
  • PO2 68
  • HCO3- 34

On his chemistry panel:

  • sodium 139
  • chloride 95
  • HCO3- 34

Acid-base status:

Alveolar-arterial oxygen difference:

Explanation for the clinical picture:

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