1. What is the interpretation of this anion gap?

Conrad Jackson is a 28-year-old man who presents to the emergency department with severe fatigue and dehydration secondary to a 4-day history of vomiting. During the interview, he describes attending a family reunion and states that perhaps he “ate something bad.” Upon admission his vital signs are a temperature of 102.7°F, heart rate of 116 bpm, respiratory rate of 18 breaths/min, and blood pressure of 86/54 mm Hg. The nurse also notes the patient has dry mucous membranes and tenting of skin. The physician orders an IV to be started with 0.45% normal saline, and orders a serum electrolytes and an arterial blood gas.

The following results are returned from the laboratory:

Sodium (Na+)             150

Potassium (K+)           5.5

Chloride (Cl¯)             110

BUN                           42

Creatinine                    0.8

Glucose                       86

pH                               7.32

PaCO2                         35

HCO3¯                        20

PaO2                            90

O2 Sat                          98%

1. What is your interpretation of this arterial blood gas sample?
2. Explain the high potassium in this patient.
3. Calculate the patient’s anion gap:
4. What is the interpretation of this anion gap?