A 21 year old man is brought in by his father with a one week history of vomiting. He has not been able to keep any food down. He has been diagnosed with Hashimoto’s thyroiditis by his local doctor 4 months previously. Today his blood pressure is 90/48 and pulse rate 104. These are his venous blood gas results:
pH 7.31
pCO2 39
pO2 25
HCO3- 19
BE -7
Na 108
K 6.2
Cl 72
Glc 3.3
Using the 7 step to ECGs:
Is it acidosis or alkalosis? ACIDOSIS
Is there adequate compensation?
What is the Anion Gap?
Is there any other process going on? Look at the delta gap.
= 5/5 = 1 so this is a pure anion gap metabolic acidosis. ( Given what I say below, I might have also expected a normal anion gap metabolic acidosis)
If we comment on the Na and K:
The Na is very low and the corrected K is (6.2 + 0.5) 6.7. This is indicative of Addison’s disease.
The patient was initially treated with 1L of normal saline stat. There was also a concern that there may have been an adrenal crisis occurring and he was given hydrocortisone IV, after which the blood pressure increase. He was admitted for slow correction of his hyponatremia and further investigation of his underlying condition.
