The patient is a 35 year -old female with AIDS brought to the emergency room with a fever of 39°C and a three month history of copious diarrhea.
On physical exam the patient is a well-developed, thin female in moderate distress. Vital signs-(supine) blood pressure 100/60. pulse 100 and (standing) blood pressure 80/40. pulse 125. respirations 18 and she was a febrile. HEENT exam was normal. Cardiac exam demonstrated an SI and S2 without S3. S4 or murmur. Lungs were clear to auscultation and percussion. The abdomen was supple and minimally tender to palpation. Bowel sounds were hyperactive. Stool was guiac negative. Extremities were without cyanosis, clubbing or edema. Neurological exam was intact
Chemistry Normal Values Arterial Blood Gas
Sodium 136 136-146 mmol/L pH 7.35 Pco2 27 mmHg P02 90 mmHg bicarbonate 14 mmol/L
Potassium 3.4 3.5-5.3 mmol/L
Chloride 112 98-108 mmol/L
Total CO2 14 23-27 mmol/L
BUN 30 7-22 mg/dl
Creatinine 1.5 0.7-1.5 mg/dl
Glucose 105 70-110 mg/dl
l.What is/are the critical course of events that are going to alter her acid-base status?
2.Review her blood gases. What is the primary acid-base abnormality?