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MD, 19 year old male college freshman, sustains multiple hematomas and bruises. He was initially brought to a local hospital where an intravenous line was inserted and he was given intravenous sodium bicarbonate. He was transferred to a tertiary hospital due to poor urine output and was advised dialysis. His last urine output was noted 10 hours prior. At the ER, he appears to be in respiratory distress. BP=80/60, HR=110/min, RR=30/min. He has pale conjunctivae. His lung fields are clear. There are multiple large tender hematomas over his flanks and thighs. His laboratories are as follows: Serum: Na 145 meq/L BUN 26 mmol/L K 7.0 meq/L Creat 450 umol/L Cl 105 meq/L CPK 9500 U ABG: pH 7.31 Urine: spgr=1.010, pH=5.5, alb=(-), glu=(-), (+) blood, paCO2 16 mmHg r rbc=10-20/hpf, wbc=2-4/hpf, (+) myoglobin, HCO3 8 meq/L (+) muddy brown casts Guide Questions and Answers: 1. What in the history and physical examination give clues to an acid-base disorder? 2. What is the acid-base disorder? 3. Is compensation adequate?
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