每日一题_2023.07.10

An anxious young woman presents to the emergency department because of acute-onset severe abdominal pain. She consumed eight or nine alcoholic drinks earlier in the evening. She also admits to using diuretics to “lose water weight.” Physical examination reveals periumbilical tenderness to palpation. Her stool is guaiac negative. Arterial blood gas analysis reveals a pH of 7.55, a bicarbonate level of 21 mEq/L, and a partial pressure of carbon dioxide of 25 mm Hg. Her sodium level is within normal limits. Which of the following is the most likely cause of her acid-base disturbance?

一名焦虑的年轻女性因急性发作的严重腹痛到急诊科就诊。晚上早些时候，她喝了八到九杯酒。她还承认使用利尿剂来“减水”。体格检查发现脐周触痛。她的大便阴性。动脉血气分析显示pH为7.55，碳酸氢盐水平为21 mEq/L，二氧化碳分压为25 mmhg。患者的钠水平在正常范围内。下列哪一项是她酸碱紊乱的最可能原因?

(A)  An accumulation of unmeasured anions as a result of hepatic metabolism of alcohol由于酒精的肝脏代谢而引起的未测量阴离子的积累

(B)  Electrolyte imbalance due to diuretic use使用利尿剂导致的电解质紊乱

(C)  Hyperventilation secondary to pain and anxiety疼痛和焦虑引起的换气过度

(D)  Hypoventilation due to the respiratory depression caused by alcohol ingestion酒精摄入引起的呼吸抑制引起的通气不足

(E)  Vomiting due to alcohol toxicity酒精中毒引起的呕吐

答案解析：

根据她的实验室数据，这个病人患有急性呼吸道感染。呼吸性碱中毒由二氧化碳丢失引起，通过肾脏排泄的碳酸氢盐增加来补偿。这个问题的关键是要认识到呼吸性碱中毒只能由通气增加引起，通气增加可能由低氧(在高海拔地区)或交感神经刺激(如焦虑、恐慌或疼痛)引起。该患者表现为焦虑和严重的腹痛，这很可能是急性酒精引起的胰腺炎的结果。焦虑和疼痛都可能导致她过度换气。

正确答案：C