Solution To "a Disoriented, Nauseated Car Wreck Victim"
Solution to "A Disoriented, Nauseated Car Wreck Victim" This is the solution to a case we presented recently. You may review the case at The patient has an increased anion gap acidosis. 2. Delta gap calculation = (observed gap - expected gap) + observed bicarbonate = (33 - 12) + 5 = 26. Thus, the patient started out with a normal bicarbonate (this excludes an underlying metabolic acidosis or alkalosis). 3. Winter's equation = 1.5 (calculated bicarbonate) + 8 (+ or -) 2 [expected pCO2] = 1.5 (2) + 8 = 11. This suggests that the hyperventilation is appropriate for the degree of metabolic acidosis. We use the mnemonic KILU for remembering the differential of anion gap acidosis: Ketoacidoses (diabetic, alcoholic, starvation) Ingestions (salicylates, ethylene glycol, methanol and, less commonly, iron and isoniazid) Anion gaps > 25 occur primarily with diabetic ketoacidosis, lactic acidosis, ethylene glycol, and methanol. In consideration of the stable vital signs and normal blood sugar, the physicians appropriately considered an ingestion. They ordered a serum osmolality. This supports a likely ingestion with either ethylene glycol or methanol. The positive calcium oxalate crystals mad Continue reading >>