MedBugs: SAQ #555

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Case: Projectile vomiting in 5-week-old

A 5-week-old boy has been brought to your ED with projectile vomiting.

1. State (5) differential diagnoses. For each, provide a key feature on history or examination that would support its presence. 5 marks

A venous gas is provided below :

Test	Result	Units	Reference range
pH	7.60		(7.35 – 7.45)
pCO2	56	mmHg	(35 – 45)
HCO3	52	mmol/L	(21 – 28)
Na	135	mmol/L	(134 – 146)
K	3.1	mmol/L	(3.4 – 5.0)
Cl	75		(98 – 108)
Glucose	2.6	mmol/L	(3.6 – 8.0)

2. State (4) abnormalities from the blood gas providing an explanation for each. 4 marks

3. Briefly state (4) key components of your initial management. 4 marks

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