A 31 yo man was brought to the ED after being found unresponsive. His wife reports he had been having lots of back pain after falling at work and was taking “some pills” for it. She also tells you that he drinks heavily every day, and has no history of illicit drug use. He is intubated in the ICU and on admission his vitals are: T35.5, HR 130, BP 70/40, RR 36 with O2 sat 100% on TV 500 RR 20 FiO2 40% PEEP 5.

Labs reveal: Na 140 K5.5 Cl 100 Bicarb 4 Cr 2.4 Lactate 9.8.  CBC, LFTs and coags are normal.

ABG: pO2 90 pCO2 15 pH 6.98  CXR is normal.

Interpret the Acid-Base status of this patient.  What additional tests would you order to help identify the toxin?

Volatile alcohol screen is negative.

Which of the following statements is untrue?

The toxin is acetaminophen

This condition may be caused by an autosomal recessive trait

Treat with fomepizole

Treat with NAC

See this article: Crit Care Med 2000; 28:1803-1807