A patient was transported to the local community hospital ED in overt respiratory distress. The most significant clinical finding was hyperventilation with LARGE tidal volumes and an EtCO2 of 9 with appropriate waveform. Patient reports a COPD pmhx. The ALS provider does not believe this is COPD-related. The provider was also baffled by the EtCO2, never seeing a value that out of normal range, despite a normal waveform.
Having transported a similar patient interfacility myself, I suspected a certain 'culprit.' Question: What etiology could lower a patient's pH that significantly, that quickly? Discuss the patients 'large' tidal volumes, minute ventilation, her pH, and resulting EtCO2. For an adult, a pH of 6.5 is incompatible with life. She was subsequently intubated by the ED physician and transferred to tertiary care.
Thoughts?
HINT: Some ethylene glycol mixtures contain an embittering agent, such as denatonium, to discourage accidental or deliberate consumption.
ReplyDeleteCoolant, or radiator ingestion.
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