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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

DOI https://doi.org/10.2147/JBM.S55464

Checked for plagiarism Yes


Kenrick Berend

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.

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