I'm guessing Peter is suggesting iv ethanol rather than the 'A&E Happy Hour'!
-----Original Message-----
From: Andy Webster [mailto:[log in to unmask]]
Sent: 25 April 2005 14:56
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
And its more expensive than a couple of Jack Daniels
Andy Webster
Registrar in Emergency Medicine
Sir Charles Gairdner Hospital
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of McCormick Simon Dr,
Consultant, A&E
Sent: 25 April 2005 21:40
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
...or fomepazole. Easier to give, works quicker and better and gives you
plenty of time to look for the underlying cause (on a CDU/HDU/medical
ward!!).
Simon McCormick
Rotherham
-----Original Message-----
From: Andy Webster [mailto:[log in to unmask]]
Sent: 25 April 2005 13:02
To: [log in to unmask]
Subject: Re: Metabolic Acidosis ( & yes the list is still alive)
I assume the glucose is normal?
Apart from ethanol the other to consider would be haemodialysis
Andy Webster
Registrar in Emergency Medicine
Sir Charles Gairdner Hospital
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Peter Cutting
Sent: 25 April 2005 19:50
To: [log in to unmask]
Subject: Metabolic Acidosis ( & yes the list is still alive)
OK in the interest of...well interest really
55 year old gentleman of the streets/kerb (after 5pm)
Found by paramedics drowsy but rousable surrounded by empty bottles of
?? what
On arrival Pulse 100 ish SR BP 115 ish sytolic, RR 16, GCS E 3 M 6 V
('TTFO' by pt) so 5
pH 7.2, C02 3.5, 02 32, BXS -10, AG 31 ( these are approx figures from
my failing memory)
BM 8
Met Hb 0
COHb insignif
45 mins later after fluid and controlled oxygen therapy
pH 7.2, C02 3.2, 02 18, bxs -20, AG 41
Lactate (borrowed ITU analyser) normal
U&Es Na 150, K 5.1, Urea 4 ish
30 mins later (what do you mean what about the 4/24 wait?)
pH 7.2 C02 3 02 17 BXS -22 AG 39
No urine available.................. without wringing out trousers
No easy access to ethylene glycol nor methanol levels
Would you start this chap on ethanol?
Peter
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