Specimen Name Result Units Range
Plasma Sodium 161 mmol/L (135-145)
Potassium 7.2 mmol/L (3.5-5.5)
Chloride 117 mmol/L (100-109)
Anion Gap 13 mmol/L (7-17)
Total Calcium 1.59 mmol/L (2.10-2.55)
ABG pH 6.89 (7.36-7.44)
PaO2 18 mmHg (70-100)
PaCO2 203 mmHg (35-45)
HCO3- 38 mmol/L (21-26)
BE 5 mmol/L (±3)
FIO2 100 % (21-100)
Hb 72 g/L (120-180)
     FO2Hb 12.9 % (96-100)
     FCOHb 0.6 % (< 2.0)
     FMetHb 3.2 % (< 1.5)
     FHHb 83 % (< 5.1)

Critically unwell / unconscious female with longstanding COPD.

 

*You might also think these are made-up, however, you can see the original scan here!
Acute on Chronic Respiratory Acidosis with Profound Hypoxaemia
  • the degree of abnormality here would be seemingly incompatible with life
  • to get to this state, there must have been prolonged chronic hypercapnoea & hypoxaemia, otherwise she could never have survived to this point
  • not surprisingly, she arrested shortly after this specimen was taken


Note:

  • 'Boston Rules of Thumb' for acid-base break-down in extreme cases!
  • e.g. predicted HCO3- →
    • all acute: 24 + 1*(200-40)/10 ≈ 40 mmol/L
    • chronic: 24 + 4*(200-40)/10 ≈ 88 mmol/L
    • *given there must have been a significant chronic element
  • the AaDO2 ≈ 713 - (1.25*200) - 18 ≈ 445 mmHg
    → a gross elevation in venous admixture