4. 1 and 3

The cause of the patient’s change in mental status is unclear. A mnemonic for possible causes of altered mental state is AEIOU TIPS with each letter of the mnemonic standing for the following (1):

Lumbar puncture may be indicated but is not indicated at this time because of lack of physical evidence of fever, meningismus, and radiography (CT scan, MRI) suggesting an indication. Furthermore, if the CT scan showed focal intracranial bleeding a lumbar puncture might result in herniation of the brainstem.

A complete blood count was performed and showed an elevated white blood cell count of WBC 19,000 cells/µL (76 % segs, 17% bands) but hemoglobin was normal (13.5 g/dL) and platelet count slightly elevated (506,000 platelets/µL).

A chest x-ray was performed (Figure 1).

Figure 1. Initial portable AP of chest.

A summary of the electrolytes, liver function tests, etc. with a comparison to values obtained 6 weeks earlier is shown in Table 1.

Table 1. Summary of laboratory values obtained in the emergency department (ED) and 6 weeks earlier during a routine outpatient visit (abnormal values in red).

Which of the following acid-base disturbances are present? (Click on the correct answer to be directed to the third of six pages)

  1. Elevated anion gap metabolic acidosis
  2. Elevated anion gap metabolic alkalosis
  3. Low anion gap metabolic acidosis
  4. Normal acid-base status
  5. Normal anion gap metabolic acidosis

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