Approach to acid-base disorders Quiz: Ace Your Exams

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A 45-year-old woman presents to the emergency department with confusion, dizziness and blurred vision. The patient’s medical history is significant for alcohol use disorder, and she does not take medication. Temperature is 37.0 °C (98.6 °F), heart rate is 108/min, respiratory rate is 24/min, blood pressure is 120/72 mmHg, and oxygen saturation is 100% on room air. On physical examination, there are decreased breath sounds in the lungs bilaterally with no crackles or wheezes. Neurological examination is significant for decreased visual acuity and nystagmus. The patient’s laboratory studies are shown below. Based on the patient's presentation and laboratory findings, which of the following conditions should be included in the differential diagnosis?

 Test     Result     Reference Range    
 Chemistry    
 Sodium     140 mEq/L     136-146 mEq/L    
 Potassium     4.0 mEq/L     3.5-5 mEq/L    
 Chloride     100 mEq/L     95-105 mEq/L    
 Bicarbonate     15 mEq/L     22-28 mEq/L    
 Albumin     4.0 g/dL     3.5-5.5 g/dL    
 Arterial blood gas         
 pH     7.21     7.35-7.45    
 PaO2     90 mm Hg     75-105 mm Hg    
 PaCO2     38 mm Hg     33-45 mm Hg    

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