MedBugs: SAQ #334

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Case: Myxoedema coma

A 60 year old female with known hypothyroidism presents with acute confusion. She is on thyroxine only. Vital signs:

Temp 36.0 C
HR 40 bpm
BP 60/40 mmHg

O2 sats 86% on room air

GCS 13

ABG on FiO2 0.4: pH 7.20 pO2 55 mmHg pCO2 60 mmHg HCO3 10 mmol/L Na 130 mmol/L K 6.0 mmol/L Cl 100 mmol/L Glucose 2.2 mmol/L

1. Complete the table below regarding the (2) main acid-base abnormalities in the ABG. Include your calculations. 4 marks

2. List (2) other abnormalities and (1) likely cause for each in this patient. 4 marks

Supportive treatment has been started, including supplemental O2, IV fluids and inotropes.

3. List (4) other specific treatments that should be given. 4 marks

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Case: Myxoedema coma

1. Complete the table below regarding the (2) main acid-base abnormalities in the ABG. Include your calculations. 4 marks

2. List (2) other abnormalities and (1) likely cause for each in this patient. 4 marks

3. List (4) other specific treatments that should be given. 4 marks

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