A 22-year-old woman has received 6 liters of isotonic saline and is awaiting transfer to the operating room for stabilization of injuries suffered in a car accident. The lab values include blood pH 7.28, PaCO2 39 mm Hg, sodium 135 mmol per liter, potassium 3.8 mmol per liter, chloride 115 mmol per liter, and bicarbonate 18 mmol per liter. What strategy would provide the best support for this patient?
Read a brief case description, then vote and comment about what the diagnosis may be and what diagnostic tests will prove useful. Follow the conversation on Facebook and Twitter with #NEJMCases.
The answer will be published on October 9 alongside the first article in the new Disorders of Fluids and Electrolytes review series, Physiological Approach to Assessment of Acid-Base Disturbances. Look for a new article each month.