Which statement best applies to the following patient's acid-base status?
A 42-year-old man is admitted to the hospital with dehydration and hypotension.
Na+ = 165 mEq/L
K+ = 4.0 mEq/L
CO2 = 32 mEq/L
Cl- = 112 mEq/L
No arterial blood gas is obtained.
A. Electrolytes indicate the presence of metabolic acidosis. B. Electrolytes indicate the presence of metabolic alkalosis. C. Need serum albumin to make any clinically useful assessment of his metabolic acid-base disorders. D. Electrolytes indicate the presence of both metabolic acidosis and metabolic alkalosis. E. Need serum lactate to make any clinically useful assessment of his metabolic acid-base disorders.
Electrolytes indicate the presence of both metabolic acidosis and metabolic alkalosis. -his anion gap is na - (co2 + cl) = 165 - (32+112) = 21, indicating a metabolic acidosis. his bicarbonate gap is (na - cl - 39) = 165 - 112 - 39 = 14, which indicates a metabolic alkalosis. note that it is not necessary to actually calculate a bicarbonate gap, since the elevated serum co2 (32 meq/l) in the presence of anion gap acidosis is enough to signify concomitant metabolic alkalosis. of course without blood gas measurements you dont know which process is predominant, but it is clear from the electrolytes that both metabolic disorders are present. you dont need to measure albumin nor lactate to make this determination.