The cold, quiet abdomen

core

A 76-year-old with atrial fibrillation, sudden severe abdominal pain out of proportion to a soft exam, and a blood pressure drifting down.

Blood gas

pH7.24

PaCO224 mmHg

HCO310 mmol/L

Na138 mmol/L

Cl100 mmol/L

K4.9 mmol/L

Lactate9.5 mmol/L

Albumin40 g/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.