Hi Dr. Topf,
We were going through the acid-base study guide and Prince Harry has us all out of sorts. His scenario is this:
Your first mistake. It is Prince William not Harry. Know your Royals. (Though I do not think royal genealogy is a board eligible topic.)
7.42 | 32 | 76
Na – 148
Cl – 98
K – 5.8
HCO3 – 28
For the primary acid-base disturbance, I would think it is respiratory alkalosis because the pH is elevated, the PCO2 is decreased, and the HCO3 is elevated.
You are correct
Then for the second acid base disturbance, I thought it would be metabolic alkalosis. His PCO2 is 32, which is down about 10. So, his bicarb should go down either 2 if acute or 4 if chronic, to either 22 or 20. Instead it is 28 which means he has excess HCO3 (base) and so has an additional alkalosis.
I tried doing the anion gap (22) and the bicarb before (38) but my understanding is that a bicarb before of 38 would also be metabolic alkalosis.
In the answers, it says that if you have an AG with alkalosis or a primary acid-base disorder, that it would be an acidosis.
If you have time, can you help me understand why his primary disorder is metabolic alkalosis, and how to apply the anion gap and bicarb before formulas to this case?
Thanks for your time.