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The tired patient

BMJ 2009; 338 doi: (Published 03 June 2009) Cite this as: BMJ 2009;338:b1623
  1. Bryan Renton, registrar in acute medicine
  1. 1Warrington Hospital, Lovely Lane, Warrington WA5 1QG
  1. bjrenton{at}

    A 66 year old female presented with a three week history of lethargy and malaise, reduced oral intake, and nausea but no vomiting. Medical history included hypertension, hypercholesterolaemia, and cervical spondylosis, and she was a lifelong smoker. Medications included simvastatin, aspirin, bendroflumethiazide, amlodipine, co-codamol, atenolol, and furosemide. Pulse oximetry showed reduced oxygen saturation (90% on air), but the patient was not tachypnoeic. She had a mild reduction in skin turgor; otherwise, the rest of her examination was unremarkable.

    The patient’s electrocardiogram is shown in the figure. In view of the reduced oxygen saturations, an arterial blood gas was performed. This test showed a pH of 7.631 (normal range 7.35-7.45), a pCO2 of 6.49 kPa (4-6 kPa), a pO2 of 7.79 kPa (10-13 kPa), a HCO3 of 59.9 mmol/l (22-26 mmol/l), and a base excess of +35.2 (−2 to +2). …

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