Intended for healthcare professionals

Endgames Spot Diagnosis

A man with altered mental status and metabolic acidosis

BMJ 2016; 353 doi: (Published 28 April 2016) Cite this as: BMJ 2016;353:i2338
  1. Abhishek Maiti, resident physician postgraduate year 21,
  2. Avash Das, postdoctoral fellow2
  1. 1Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
  2. 2Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
  1. Correspondence to: A Maiti abhishek.maiti{at}

A 52 year old man was brought to the emergency department for acute onset shortness of breath and confusion. On physical examination he was agitated and taking deep breaths at the rate of 28/min. Initial venous blood gas on ambient air showed pH 7.02, partial pressure of carbon dioxide 3.4 kPa, partial pressure of oxygen 4.1 kPa. …

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