12/4/2016

BMJ OnExamination Assessment : REF2889 : REF2889

Work Smart
Question 1 of 2
A 39-year-old woman presented to the Emergency department giving a two week history of palpitations and breathlessness. She had a past history of
diabetes mellitus, well controlled on metformin 850 mg bd. She was also being treated for longstanding hypertension for which she had been on
therapy for several years.
Her current medications comprised: captopril 50 mg bd; furosemide 40 mg od; and nifedipine 20 mg bd. She had recently consulted her GP with the
symptoms of breathlessness and he had increased the dose of furosemide to 80 mg od.
On examination she was overweight and appeared distressed. She was afebrile. Her pulse 120, regular; BP 145/95 mmHg. Heart sounds 1 and 2 normal
with no added sounds or murmurs. Respiratory rate 28/minute; chest clear to auscultation. The rest of the examination was normal.
Investigations revealed:
Hb

134 g/L

(115-165)

WBC

8.9 109/L

(4-11)

Platelets

199 109/L

(150-400)

Sodium

139 mmol/L

(137-144)

Potassium

4.4 mmol/L

(3.5-4.9)

Urea

5.8 mmol/L

(2.5-7.5)

Creatinine

110 mol/L

(60-110)

Glucose

5.9 mmol/L

(3.0-6.0)

Arterial blood gases on air:

pH

7.6

(7.36-7.44)

O2 Saturation

99%

PaO2

112 mmHg/15 kPa

(75-100)

PaCO2

13.7 mmHg/1.8 kPa

(35-45)

Standard bicarbonate

20 mmol/L

(20-28)

Base excess

-7.0 mmol/L

(2)

Chest x ray: Normal

What treatment should be given?
(Please select 1 option)
Aminophylline infusion
Beta blocker per orally
Breathe into a paper bag

Correct

Nebulised bronchodilators
Stop metformin
The patient has a respiratory alkalosis as a result of hyperventilation. Breathing into a paper bag and reassurance should help to stabalise the patient in
this case.
Panic attacks may present with deranged ABG result, including respiratory alkalosis.
Paper bag rebreathing should be administered with caution, particularly in patients with possible respiratory or cardiac pathology
http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=11357370

1/2

12/4/2016

BMJ OnExamination Assessment : REF2889 : REF2889

Next question
Go to summary

Answer Statistics
1

1%

4%

53%

2%

8%

Times answered: 6453

Test Analysis

Correct
Incorrect
Partially Correct

Score: 100%
Total Answered: 1

Feedback
Question Navigator
Revision Notes
Tags

2016 BMJ Publishing Group Ltd . All rights reserved.

ICP15042040-3
Contact (http://onexamination.com/more/contact) . Corporate (http://onexamination.com/more/corporate) . Terms and conditions & Privacy policy (http://www.onexamination.com/more/legal)
(http://company.bmj.com)

http://my.onexamination.com/GenericAssessment/GenericAssessmentQuestion.aspx?AssessmentId=11357370

2/2