每日一题_2022.4.6

A 64-year-old man is transferred to the ICU from a hospital floor two weeks after a bone marrow transplant. He has a temperature of 39.4°C (103°F), a heart rate of 125 beats/min, tachypnea, and an oxygen saturation of 95% on room air. His arterial blood gas analysis reveals pH 7.45, carbon dioxide 23 mm Hg, and oxygen 63 mm Hg. Sodium 133 mEq/L, potassium 3.5 mEq/L, chloride 104 mEq/L, bicarbonate 18 mEq/L, blood urea nitrogen 7.0 mg/dL, creatinine of 0.9 mg/dL, with an albumin of 1.4 g/dL.

Which of the following best describes his metabolic status?

A. Non-anion gap metabolic acidosis with respiratory compensation 

B. Primary respiratory alkalosis and metabolic alkalosis

C. Mixed respiratory alkalosis and non-anion gap acidosis

D. Mixed respiratory alkalosis and anion gap acidosis

答案解析：

患者患有轻度碱血症，pH值为7.45。他的二氧化碳水平为23 mmHg，与呼吸性碱中毒一致。然而，pH值低于二氧化碳值23 mmHg的预期值，表明存在混合工艺。碳酸氢盐水平为18 mEq/L，提示代谢性酸中毒。计算得出阴离子间隙为11 mEq/L(133-(104 + 18))。然而，白蛋白仅为1.4 g/dL，而正常水平为4 g/dL。白蛋白每降低1 g/dL，阴离子间隙应升高约2.5 mEq/L，导致最终值为17.5 mEq/L。

正确答案：D

补充内容：