Metabolic acidosis Quiz: Ace Your Exams

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A 21-year old woman is brought to the emergency room after intentionally ingesting 60 tablets of an unknown medication in a suicide attempt. She says that her life has become unbearable, and she is constantly depressed. She notices a ringing in her ears and feels nauseated. Her medical history is significant for two prior suicide attempts and inpatient psychiatric treatment for bipolar disorder. Her temperature is 37.1°C (98.8°F), pulse is 86/min, respirations are 16/min, and blood pressure is 124/90 mmHg. Physical examination shows a disheveled, lethargic female; external auditory canals are normal bilaterally with pinkish-grey, translucent tympanic membranes in the neutral position. Laboratory studies show the following:

Laboratory value	Result
Serum chemistry
Sodium	145 mEq/L
Potassium	3.4 mEq/L
Chloride	110 mEq/L
Bicarbonate	15 mEq/L
Arterial blood gas
pH	7.30
PaCO2	26 mmHg
PaO2	120 mmHg

Which of the following best describes this patient’s acid-base status?

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Primary respiratory acidosis with superimposed metabolic alkalosis

Pure respiratory acidosis

Pure metabolic acidosis

Primary metabolic acidosis with superimposed respiratory acidosis

Primary metabolic acidosis with superimposed respiratory alkalosis

Primary respiratory acidosis with superimposed metabolic acidosis