Tingling fingers in the waiting room

intro

A 22-year-old with acute anxiety, perioral tingling, and carpal spasm. Breathing 32 times a minute.

Blood gas

pH7.54

PaCO224 mmHg

HCO321 mmol/L

PaO2108 mmHg

Na140 mmol/L

Cl104 mmol/L

K3.8 mmol/L

No high/low cues on purpose: read the numbers the way the gas machine prints them.

Stepwise interpretation

Commit to your own read first: pH, primary process, compensation, gap, delta, oxygenation. Then walk the engine’s steps and see where you agree.