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A 64-year-old man with agitation and a history of alcohol abuse has been brought to the emergency department. His laboratory data include: blood pH 7.07, PCO2 12.6 mm Hg, PO2 55 mm Hg; sodium 133 mmol/liter, potassium 4.1 mmol/liter, chloride 93 mmol/liter, and bicarbonate 3.9 mmol/liter. The full case can be reviewed here.
What strategy would provide the best support for this patient?
A recent NEJM review article, "Integration of Acid-Base and Electrolyte Disorders," describes an approach to acid-base disorders that incorporates insights and examples drawn from the traditional, bicarbonate-centered approach and the physicochemical or strong ion theory. Ask the author and experts in the field your questions on this topic.