Sam is a 35 y/o alcoholic who is brought to the ER in a comatose state. Sam’s wife tells you that she had an argument in the evening about 5 hrs ago over Sam’s alcohol habits. Sam apparently got mad over the discussion, drove his car and returned an hour ago in a very intoxicated state. Wife called the EMS and rushed him to the ER. On examination Sam is disoriented and hallucinating , Pulse 120 Tm 99, RR 26 BP 126/76. The rest of the physical exam is normal except for stuporos state and alcohol smell. Lab studies revealed Na 130 k 3.4 cl- 95 Hco3 16, Glucose 90 Creatinine 1.6 BUN 45. Blood Ethylalcohol level was 180. Serum osmolarity was 360mg%. ABGs revealed 7.28, Pco2 28, Po2 76 Sao2 93. The next best step in management ?
A) Endotracheal intubation in view of severe acidosis
B) Hemodialysis because this is an acute renal failure causing acidosis
C) Fomepizole because of suspicion of ethylene glycol intoxication
D) Supportive treatment for now because this is an ethylalcohol induced lactic acidosis
E) Bicarbonate drip to reverse the acidosis because this is renal tubular acidosis
a
D. vitals are stable except pulse. but suportive care will work. No need to intubate the patient.
d
D
D
this could be ethylene glycol poisoning.
b. Does meet the criteria for hemodialysis
C
Endotracheal intubation NOT required because patient lung nicely work just see the pco2.
d
b
taking a stab
c to protect the kidney…
Answer A
Hypoglycemia and respiratory depression are the 2 most immediate life-threatening complications that result from ethanol intoxication
Assess the airway. If necessary, secure the airway with an endotracheal (ET) tube if the patient is not maintaining good ventilation or if a significant risk of aspiration is observed. Provide respiratory support and mechanical ventilation if needed.
The pH can help in ruling out the co-ingestion of methanol and ethylene glycol, because significant acidemia is associated with those ingestions. However, reports in the literature have documented that the co-ingestion of ethanol and methanol does not cause significant acidosis
d
ans please ? is it a or c ?
d,please Dr HELP AS
remember the ABCs
you must intubate to protect aspiration and the metobolic acidosis with resp compensation state.Regulation of RR is important. Also IV in both arm, Fluids, Glucose control, Blood alch.levels obtained as well as toxicology.If no improvement more aggressive measures should be taken
dr red explain plz
A patient is comatose in severe metabolic acidosis, protect the airway