Ringing ears and a strange gas

advanced

A 26-year-old presents six hours after a large aspirin ingestion, hyperventilating with tinnitus.

Blood gas

pH7.42

PaCO221 mmHg

HCO313 mmol/L

PaO2104 mmHg

Na139 mmol/L

Cl103 mmol/L

K3.6 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.