Intended for healthcare professionals

Endgames Case Report

Metabolic alkalosis in a patient with dyspnoea

BMJ 2013; 346 doi: (Published 02 May 2013) Cite this as: BMJ 2013;346:f2710
  1. Richard Windsor, foundation year 2, obstetrics and gynaecology1,
  2. Will Petchey, registrar, renal medicine2
  1. 1Queen Elizabeth Hospital, King’s Lynn PE30 4ET, UK
  2. 2Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to: R Windsor Richard.windsor{at}

A 56 year old woman with poorly controlled asthma was admitted to hospital with a suspected lower respiratory tract infection, having become increasingly anxious and short of breath over the past 24 hours. She had been unwell for the past week, and her general practitioner had started her on amoxicillin and oral steroids. She was a never smoker, had a history of ischaemic heart disease and atrial fibrillation, and had a high body mass index. This was not the first time she had been admitted to hospital with an exacerbation of her asthma, having been admitted several times previously. Her regular drugs included fluticasone, salbutamol, furosemide, omeprazole, simvastatin, and diltiazem.

On examination she had a normal temperature, a respiratory rate of 26 breaths/min, sparse crackles at her left lung base, together with widespread expiratory wheeze. The table details her initial arterial blood gases on air and other blood test results.

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Initial arterial blood gases on …

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