Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa type
Authors Berend K
Received 5 October 2013
Accepted for publication 12 October 2013
Published 9 December 2013 Volume 2013:4 Pages 161—162
Checked for plagiarism Yes
St Elisabeth Hospital, Willemstad, Curaçao
Imashuku et al1 describe a 77-year-old male patient with multiple myeloma who was admitted to the hospital after suffering a pelvic bone fracture due to a road traffic accident. Several days after admission the arterial blood gas showed a pH of 7.481; arterial carbon dioxide tension (PaCO2) of 28.2 mmHg; arterial oxygen tension (PaO2) of 84.0 mmHg; HCO3- of 20.8 mmol/L (normal; 23–31 mmol/L); and an anion gap of 8.9 mmol/L (normal;12 mmol/L). These data, as the authors concluded, were suggestive of metabolic acidosis. First, this is not true because a high pH and low PaCO2 confirm a respiratory alkalosis. Since the test was conducted days later we may expect a chronic respiratory alkalosis to be present, perhaps because of pain or a secondary pulmonary problem, as may be expected with a relatively low PaO2. In chronic respiratory alkalosis one would expect the HCO3- to decrease about 4 mmol/L with every 10 mmHg decrease of PaCO2.2 If the initial HCO3- had been about 25 mmol/L, the expected PaCO2 would be about 20.28 mmol/L, almost identical with the patient’s HCO3-.
View original paper by Imashuku and colleagues.
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]