Mixed acid-base disorders

Abstract

A 55-year-old man presents with a 3-day history of severe nausea and vomiting following an alcohol binge. He says that he has not been able to take anything by mouth for the past 3 days, and he complains about diffuse abdominal pain. On admission his blood pressure is 129/77 mmHg with a heart rate of 77 bpm supine and 105/62 mmHg with a heart rate of 92 bpm standing up. He is a febrile. He looks emaciated, has poor skin turgor, and dry mucous membranes. His bowel sounds appear diminished, and an abdominal X-ray shows small bowel ileus. On admission to the emergency room the laboratory data shown in Table 16.1 are obtained. What, if any, acid-base disturbance is present?