The Gas Goblin

Exercises in arterial and venous blood gas interpretation.

Goblin
Status epilepticus
The Ongoing Storm Within

A 42-year-old woman arrives actively seizing with a GCS of 3.

  • ABG
  • pH: 7.08 (7.35 – 7.45)
  • pO₂: 92 mmHg (75 – 100)
  • pCO₂: 48 mmHg (35 – 45)
  • HCO₃⁻: 12 mmol/L (22 – 26)
  • BE: -16 mmol/L (-3 – 3)
  • SaO₂: 96 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.5 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 14 mmol/L
  • Glucose: 9 mmol/L (4 – 8)
  • Urea: 7 mmol/L
  • Creatinine: 85 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 1

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Goblin
Iatrogenic bicarbonate infusion
The Treatment That Overshot

A 63-year-old man with diabetic ketoacidosis received large boluses of bicarbonate at another facility before transfer.

  • ABG
  • pH: 7.56 (7.35 – 7.45)
  • pO₂: 95 mmHg (75 – 100)
  • pCO₂: 50 mmHg (35 – 45)
  • HCO₃⁻: 45 mmol/L (22 – 26)
  • BE: 18 mmol/L (-3 – 3)
  • SaO₂: 98 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 2.8 mmol/L (3.5 – 5.5)
  • Cl: 88 mmol/L (95 – 110)
  • Ca: 1.1 mmol/L (1.12 – 1.3)
  • Lactate: 1.5 mmol/L
  • Glucose: 10 mmol/L (4 – 8)
  • Urea: 8 mmol/L
  • Creatinine: 95 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

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Goblin
Exertional heat stroke
The Collapse in the Heat

A 19-year-old athlete collapses during a marathon on a 38°C day. He is confused, tachypnoeic and hypotensive.

  • ABG
  • pH: 7.26 (7.35 – 7.45)
  • pO₂: 98 mmHg (75 – 100)
  • pCO₂: 30 mmHg (35 – 45)
  • HCO₃⁻: 14 mmol/L (22 – 26)
  • BE: -10 mmol/L (-3 – 3)
  • SaO₂: 98 % (94 – 100)
  • Na⁺: 132 mmol/L (135 – 145)
  • K⁺: 4.8 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.16 mmol/L (1.12 – 1.3)
  • Lactate: 7 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 8 mmol/L
  • Creatinine: 100 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

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Goblin
Volunteer
The Calm Control Sample

A healthy 50-year-old man has a VBG taken as part of a research study.

  • VBG
  • pH: 7.36 (7.35 – 7.45)
  • pO₂: 40 mmHg (75 – 100)
  • pCO₂: 48 mmHg (35 – 45)
  • HCO₃⁻: 26 mmol/L (22 – 26)
  • BE: 1 mmol/L (-3 – 3)
  • SaO₂: 75 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.2 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 1.1 mmol/L
  • Glucose: 5.2 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 90 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %

💀

Goblin
Thyroid storm with lactic acidosis
The Body in Overdrive

A 40-year-old woman with known Graves’ disease presents with fever, tachycardia, vomiting and agitation.

  • ABG
  • pH: 7.35 (7.35 – 7.45)
  • pO₂: 110 mmHg (75 – 100)
  • pCO₂: 30 mmHg (35 – 45)
  • HCO₃⁻: 16 mmol/L (22 – 26)
  • BE: -8 mmol/L (-3 – 3)
  • SaO₂: 100 % (94 – 100)
  • Na⁺: 136 mmol/L (135 – 145)
  • K⁺: 4.8 mmol/L (3.5 – 5.5)
  • Cl: 98 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 6 mmol/L
  • Glucose: 8 mmol/L (4 – 8)
  • Urea: 5 mmol/L
  • Creatinine: 65 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

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Goblin
Early refeeding syndrome
The First Feeds Trouble

A 29-year-old woman with severe malnutrition is started on NG feeding and later becomes tachycardic and confused.

  • ABG
  • pH: 7.51 (7.35 – 7.45)
  • pO₂: 100 mmHg (75 – 100)
  • pCO₂: 28 mmHg (35 – 45)
  • HCO₃⁻: 22 mmol/L (22 – 26)
  • BE: -1 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 136 mmol/L (135 – 145)
  • K⁺: 3.2 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 3 mmol/L
  • Creatinine: 40 μmol/L
  • Osmolarity: 280 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

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Goblin
Missed dialysis with severe metabolic acidosis
The Weeks That Slipped By

A 67-year-old man on haemodialysis missed his last two sessions and presents with vomiting, weakness and confusion.

  • ABG
  • pH: 7.12 (7.35 – 7.45)
  • pO₂: 95 mmHg (75 – 100)
  • pCO₂: 28 mmHg (35 – 45)
  • HCO₃⁻: 9 mmol/L (22 – 26)
  • BE: -18 mmol/L (-3 – 3)
  • SaO₂: 98 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 7.2 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.05 mmol/L (1.12 – 1.3)
  • Lactate: 2.5 mmol/L
  • Glucose: 5.5 mmol/L (4 – 8)
  • Urea: 36 mmol/L
  • Creatinine: 880 μmol/L
  • Osmolarity: 330 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

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Goblin
Bronchiolitis
The Baby Who Worked to Breathe

An 11-month-old infant with RSV bronchiolitis presents with recession, tachypnoea and poor feeding.

  • ABG
  • pH: 7.28 (7.35 – 7.45)
  • pO₂: 65 mmHg (75 – 100)
  • pCO₂: 60 mmHg (35 – 45)
  • HCO₃⁻: 26 mmol/L (22 – 26)
  • BE: -1 mmol/L (-3 – 3)
  • SaO₂: 92 % (94 – 100)
  • Na⁺: 136 mmol/L (135 – 145)
  • K⁺: 4.2 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.28 mmol/L (1.12 – 1.3)
  • Lactate: 2 mmol/L
  • Glucose: 5 mmol/L (4 – 8)
  • Urea: 4 mmol/L
  • Creatinine: 20 μmol/L
  • Osmolarity: 275 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.3

💀 💀

Goblin
Pregnancy
The Two Heartbeats Visit

A 31-year-old woman at 32 weeks gestation presents with mild dyspnoea and is being evaluated for PE but is otherwise …

  • ABG
  • pH: 7.47 (7.35 – 7.45)
  • pO₂: 105 mmHg (75 – 100)
  • pCO₂: 28 mmHg (35 – 45)
  • HCO₃⁻: 19 mmol/L (22 – 26)
  • BE: -2 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 136 mmol/L (135 – 145)
  • K⁺: 3.7 mmol/L (3.5 – 5.5)
  • Cl: 104 mmol/L (95 – 110)
  • Ca: 1.1 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 4.6 mmol/L (4 – 8)
  • Urea: 2.5 mmol/L
  • Creatinine: 45 μmol/L
  • Osmolarity: 275 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀

Goblin
ARDS
The Stiff Lungs on Arrival

A 58-year-old woman with septic shock from pneumococcal pneumonia is on low tidal volume ventilation and vasopressors in ED.

  • ABG
  • pH: 7.21 (7.35 – 7.45)
  • pO₂: 62 mmHg (75 – 100)
  • pCO₂: 55 mmHg (35 – 45)
  • HCO₃⁻: 21 mmol/L (22 – 26)
  • BE: -6 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.6 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.14 mmol/L (1.12 – 1.3)
  • Lactate: 6.8 mmol/L
  • Glucose: 9.5 mmol/L (4 – 8)
  • Urea: 12 mmol/L
  • Creatinine: 120 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.7

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Goblin
Paediatric post-ictal lactic acidosis
The Quiet After the Storm

A 6-year-old boy arrives after a 3-minute generalised tonic–clonic seizure. He is drowsy but rousable.

  • ABG
  • pH: 7.25 (7.35 – 7.45)
  • pO₂: 98 mmHg (75 – 100)
  • pCO₂: 30 mmHg (35 – 45)
  • HCO₃⁻: 13 mmol/L (22 – 26)
  • BE: -10 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4 mmol/L (3.5 – 5.5)
  • Cl: 101 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 10 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 3 mmol/L
  • Creatinine: 30 μmol/L
  • Osmolarity: 275 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Myxoedema coma
The Cold, Slow Body

A 70-year-old woman with known hypothyroidism is brought in by family with hypothermia, bradycardia and reduced consciousness.

  • ABG
  • pH: 7.25 (7.35 – 7.45)
  • pO₂: 80 mmHg (75 – 100)
  • pCO₂: 55 mmHg (35 – 45)
  • HCO₃⁻: 23 mmol/L (22 – 26)
  • BE: -2 mmol/L (-3 – 3)
  • SaO₂: 92 % (94 – 100)
  • Na⁺: 128 mmol/L (135 – 145)
  • K⁺: 4.5 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.12 mmol/L (1.12 – 1.3)
  • Lactate: 2 mmol/L
  • Glucose: 3.8 mmol/L (4 – 8)
  • Urea: 10 mmol/L
  • Creatinine: 110 μmol/L
  • Osmolarity: 270 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.28

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Goblin
High altitude acute mountain sickness
The Thin Air at Dawn

A 30-year-old trekker presents with headache, nausea and dizziness at 3,800 metres altitude.

  • ABG
  • pH: 7.52 (7.35 – 7.45)
  • pO₂: 55 mmHg (75 – 100)
  • pCO₂: 22 mmHg (35 – 45)
  • HCO₃⁻: 18 mmol/L (22 – 26)
  • BE: -4 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 3.9 mmol/L (3.5 – 5.5)
  • Cl: 105 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 1.5 mmol/L
  • Glucose: 5.5 mmol/L (4 – 8)
  • Urea: 4 mmol/L
  • Creatinine: 65 μmol/L
  • Osmolarity: 280 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Sepsis with respiratory fatigue
The Breaths That Slowly Faded

A 52-year-old woman with severe sepsis initially hyperventilates but later becomes fatigued and hypoventilates.

  • ABG
  • pH: 7.22 (7.35 – 7.45)
  • pO₂: 80 mmHg (75 – 100)
  • pCO₂: 46 mmHg (35 – 45)
  • HCO₃⁻: 18 mmol/L (22 – 26)
  • BE: -8 mmol/L (-3 – 3)
  • SaO₂: 95 % (94 – 100)
  • Na⁺: 139 mmol/L (135 – 145)
  • K⁺: 4.7 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.16 mmol/L (1.12 – 1.3)
  • Lactate: 6.5 mmol/L
  • Glucose: 8 mmol/L (4 – 8)
  • Urea: 10 mmol/L
  • Creatinine: 105 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.28

💀 💀 💀 💀

Goblin
Hypercapnic encephalopathy with vomiting
The Sleepy, Spinning Room

An 82-year-old woman with COPD is brought in drowsy with several days of vomiting and poor intake.

  • ABG
  • pH: 7.44 (7.35 – 7.45)
  • pO₂: 65 mmHg (75 – 100)
  • pCO₂: 60 mmHg (35 – 45)
  • HCO₃⁻: 40 mmol/L (22 – 26)
  • BE: 14 mmol/L (-3 – 3)
  • SaO₂: 90 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 3 mmol/L (3.5 – 5.5)
  • Cl: 82 mmol/L (95 – 110)
  • Ca: 1.17 mmol/L (1.12 – 1.3)
  • Lactate: 1.5 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 12 mmol/L
  • Creatinine: 120 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.28

💀 💀 💀 💀

Goblin
Isopropanol ingestion
The Bottle Under the Sink

A 39-year-old man presents intoxicated after drinking rubbing alcohol. He is vomiting but haemodynamically stable.

  • ABG
  • pH: 7.39 (7.35 – 7.45)
  • pO₂: 100 mmHg (75 – 100)
  • pCO₂: 40 mmHg (35 – 45)
  • HCO₃⁻: 24 mmol/L (22 – 26)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 3.8 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 1.5 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 7 mmol/L
  • Creatinine: 90 μmol/L
  • Osmolarity: 340 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Ethylene glycol toxicity
The Sweet Taste of Danger

A 44-year-old man is brought in by friends after drinking 'sweet tasting alcohol'. He is tachypnoeic, confused and has flank …

  • ABG
  • pH: 7.03 (7.35 – 7.45)
  • pO₂: 96 mmHg (75 – 100)
  • pCO₂: 18 mmHg (35 – 45)
  • HCO₃⁻: 5 mmol/L (22 – 26)
  • BE: -22 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 5 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.05 mmol/L (1.12 – 1.3)
  • Lactate: 4 mmol/L
  • Glucose: 7 mmol/L (4 – 8)
  • Urea: 12 mmol/L
  • Creatinine: 220 μmol/L
  • Osmolarity: 360 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

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Goblin
Milk-alkali syndrome
The Calcium Conundrum

A 65-year-old man taking large amounts of calcium carbonate for indigestion presents with confusion, polyuria and abdominal pain.

  • ABG
  • pH: 7.54 (7.35 – 7.45)
  • pO₂: 98 mmHg (75 – 100)
  • pCO₂: 50 mmHg (35 – 45)
  • HCO₃⁻: 42 mmol/L (22 – 26)
  • BE: 16 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 142 mmol/L (135 – 145)
  • K⁺: 3.2 mmol/L (3.5 – 5.5)
  • Cl: 88 mmol/L (95 – 110)
  • Ca: 1.48 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 20 mmol/L
  • Creatinine: 180 μmol/L
  • Osmolarity: 298 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Aspirin (salicylate) toxicity
The Ringing in the Ears

A 27-year-old woman presents with tinnitus, vomiting and hyperventilation after an overdose of aspirin tablets 6 hours earlier.

  • ABG
  • pH: 7.45 (7.35 – 7.45)
  • pO₂: 110 mmHg (75 – 100)
  • pCO₂: 22 mmHg (35 – 45)
  • HCO₃⁻: 14 mmol/L (22 – 26)
  • BE: -6 mmol/L (-3 – 3)
  • SaO₂: 100 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 3.4 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 3 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 5 mmol/L
  • Creatinine: 70 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀

Goblin
Acute iron poisoning
The Shiny Red Tablets

A 4-year-old girl presents vomiting blood after ingesting a large number of her mother’s iron tablets.

  • ABG
  • pH: 7.2 (7.35 – 7.45)
  • pO₂: 90 mmHg (75 – 100)
  • pCO₂: 28 mmHg (35 – 45)
  • HCO₃⁻: 11 mmol/L (22 – 26)
  • BE: -14 mmol/L (-3 – 3)
  • SaO₂: 97 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.8 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 6 mmol/L
  • Glucose: 7 mmol/L (4 – 8)
  • Urea: 5 mmol/L
  • Creatinine: 40 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀

Goblin
Metformin-associated lactic acidosis (MALA)
The Slow Poisoning Days

A 68-year-old woman with type 2 diabetes and CKD becomes critically unwell with vomiting and confusion after several days of …

  • ABG
  • pH: 7.04 (7.35 – 7.45)
  • pO₂: 95 mmHg (75 – 100)
  • pCO₂: 22 mmHg (35 – 45)
  • HCO₃⁻: 6 mmol/L (22 – 26)
  • BE: -20 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 6.8 mmol/L (3.5 – 5.5)
  • Cl: 104 mmol/L (95 – 110)
  • Ca: 1.17 mmol/L (1.12 – 1.3)
  • Lactate: 14 mmol/L
  • Glucose: 7 mmol/L (4 – 8)
  • Urea: 22 mmol/L
  • Creatinine: 330 μmol/L
  • Osmolarity: 305 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀 💀

Goblin
Combined CO and cyanide inhalation
The Fire and the Fumes

A 33-year-old man is rescued from a house fire. He is confused, tachypnoeic and covered in soot.

  • ABG
  • pH: 7.12 (7.35 – 7.45)
  • pO₂: 180 mmHg (75 – 100)
  • pCO₂: 55 mmHg (35 – 45)
  • HCO₃⁻: 14 mmol/L (22 – 26)
  • BE: -10 mmol/L (-3 – 3)
  • SaO₂: 100 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 5.2 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.1 mmol/L (1.12 – 1.3)
  • Lactate: 12 mmol/L
  • Glucose: 7 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 95 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 25 % (0.2 – 2)
  • MetHb: 2 %
  • fiO2: 1

💀 💀 💀 💀 💀

Goblin
Organophosphate poisoning
The Farmer in the Field

A 55-year-old farmer is found confused and sweating profusely beside an open pesticide container. He has pinpoint pupils, wheeze and …

  • ABG
  • pH: 7.22 (7.35 – 7.45)
  • pO₂: 70 mmHg (75 – 100)
  • pCO₂: 32 mmHg (35 – 45)
  • HCO₃⁻: 12 mmol/L (22 – 26)
  • BE: -12 mmol/L (-3 – 3)
  • SaO₂: 92 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.8 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.16 mmol/L (1.12 – 1.3)
  • Lactate: 5 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 8 mmol/L
  • Creatinine: 90 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀

Goblin
Amyl nitrite toxicity with methaemoglobinemia
The Grey Skin Mystery

A 24-year-old man presents with dizziness and dyspnoea after using amyl nitrite recreationally. He has slate-grey skin and chocolate-coloured blood.

  • ABG
  • pH: 7.3 (7.35 – 7.45)
  • pO₂: 100 mmHg (75 – 100)
  • pCO₂: 36 mmHg (35 – 45)
  • HCO₃⁻: 18 mmol/L (22 – 26)
  • BE: -6 mmol/L (-3 – 3)
  • SaO₂: 85 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.1 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.14 mmol/L (1.12 – 1.3)
  • Lactate: 3 mmol/L
  • Glucose: 5 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 75 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 22 %
  • fiO2: 1

💀 💀 💀 💀

Goblin
Methanol toxicity
The Snowy Vision

A 48-year-old man is brought by friends after drinking homemade spirits. He is vomiting and complaining of blurred vision: 'everything …

  • ABG
  • pH: 7.05 (7.35 – 7.45)
  • pO₂: 95 mmHg (75 – 100)
  • pCO₂: 20 mmHg (35 – 45)
  • HCO₃⁻: 6 mmol/L (22 – 26)
  • BE: -24 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 142 mmol/L (135 – 145)
  • K⁺: 4.5 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 3 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 8 mmol/L
  • Creatinine: 100 μmol/L
  • Osmolarity: 360 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀 💀

Goblin
Paracetamol toxicity with hepatic failure
The Yellowing Hours

A 29-year-old woman presents 36 hours after a large paracetamol ingestion with jaundice, vomiting and confusion.

  • ABG
  • pH: 7.32 (7.35 – 7.45)
  • pO₂: 98 mmHg (75 – 100)
  • pCO₂: 25 mmHg (35 – 45)
  • HCO₃⁻: 12 mmol/L (22 – 26)
  • BE: -14 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.3 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.12 mmol/L (1.12 – 1.3)
  • Lactate: 4.5 mmol/L
  • Glucose: 4 mmol/L (4 – 8)
  • Urea: 5 mmol/L
  • Creatinine: 70 μmol/L
  • Osmolarity: 280 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀

Goblin
Septic shock in a chronic CO₂ retainer
The Fever That Broke the Balance

A 71-year-old man with severe COPD presents with fever, hypotension and altered mentation. He is known to chronically run high …

  • ABG
  • pH: 7.18 (7.35 – 7.45)
  • pO₂: 58 mmHg (75 – 100)
  • pCO₂: 70 mmHg (35 – 45)
  • HCO₃⁻: 24 mmol/L (22 – 26)
  • BE: -4 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.8 mmol/L (3.5 – 5.5)
  • Cl: 104 mmol/L (95 – 110)
  • Ca: 1.16 mmol/L (1.12 – 1.3)
  • Lactate: 7 mmol/L
  • Glucose: 8 mmol/L (4 – 8)
  • Urea: 16 mmol/L
  • Creatinine: 140 μmol/L
  • Osmolarity: 305 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.4

💀 💀 💀 💀 💀

Goblin
DKA with pneumonia
The Double-Edged Storm

A 36-year-old woman with type 1 diabetes presents with abdominal pain, tachypnoea and fever. She is clinically dehydrated with right-sided …

  • ABG
  • pH: 7.08 (7.35 – 7.45)
  • pO₂: 58 mmHg (75 – 100)
  • pCO₂: 38 mmHg (35 – 45)
  • HCO₃⁻: 11 mmol/L (22 – 26)
  • BE: -16 mmol/L (-3 – 3)
  • SaO₂: 89 % (94 – 100)
  • Na⁺: 130 mmol/L (135 – 145)
  • K⁺: 5.3 mmol/L (3.5 – 5.5)
  • Cl: 94 mmol/L (95 – 110)
  • Ca: 1.14 mmol/L (1.12 – 1.3)
  • Lactate: 4 mmol/L
  • Glucose: 28 mmol/L (4 – 8)
  • Urea: 15 mmol/L
  • Creatinine: 160 μmol/L
  • Osmolarity: 320 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.4

💀 💀 💀 💀 💀

Goblin
Abdominal sepsis with mixed disorder
The Fire in the Belly

A 73-year-old man presents with severe abdominal pain, peritonism and fever. He is tachypnoeic, hypotensive and confused.

  • ABG
  • pH: 7.32 (7.35 – 7.45)
  • pO₂: 72 mmHg (75 – 100)
  • pCO₂: 25 mmHg (35 – 45)
  • HCO₃⁻: 12 mmol/L (22 – 26)
  • BE: -14 mmol/L (-3 – 3)
  • SaO₂: 95 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.3 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.15 mmol/L (1.12 – 1.3)
  • Lactate: 6 mmol/L
  • Glucose: 9 mmol/L (4 – 8)
  • Urea: 10 mmol/L
  • Creatinine: 125 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.4

💀 💀 💀 💀

Goblin
Diuretic toxicity in COPD with APO
The Confused Breathless Elder

An 84-year-old woman with COPD and heart failure is brought in confused and hypoxic after several days of increasing frusemide …

  • ABG
  • pH: 7.42 (7.35 – 7.45)
  • pO₂: 65 mmHg (75 – 100)
  • pCO₂: 60 mmHg (35 – 45)
  • HCO₃⁻: 38 mmol/L (22 – 26)
  • BE: 14 mmol/L (-3 – 3)
  • SaO₂: 90 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 3 mmol/L (3.5 – 5.5)
  • Cl: 88 mmol/L (95 – 110)
  • Ca: 1.17 mmol/L (1.12 – 1.3)
  • Lactate: 3 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 18 mmol/L
  • Creatinine: 165 μmol/L
  • Osmolarity: 300 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.4

💀 💀 💀 💀 💀

Goblin
Severe gastroenteritis with dehydration
The Drained Traveller

A 29-year-old man presents with 3 days of profuse vomiting and diarrhoea, lightheadedness and oliguria.

  • VBG
  • pH: 7.29 (7.35 – 7.45)
  • pO₂: 49 mmHg (75 – 100)
  • pCO₂: 30 mmHg (35 – 45)
  • HCO₃⁻: 14 mmol/L (22 – 26)
  • BE: -10 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 134 mmol/L (135 – 145)
  • K⁺: 3 mmol/L (3.5 – 5.5)
  • Cl: 108 mmol/L (95 – 110)
  • Ca: 1.15 mmol/L (1.12 – 1.3)
  • Lactate: 1.5 mmol/L
  • Glucose: 5.8 mmol/L (4 – 8)
  • Urea: 15 mmol/L
  • Creatinine: 140 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀

Goblin
Laxative and diuretic overuse
The Pills Behind the Palpitations

A 23-year-old woman presents with dizziness and palpitations. Her meds include OTC laxatives and ‘diet pills’ purchased online.

  • VBG
  • pH: 7.5 (7.35 – 7.45)
  • pO₂: 39 mmHg (75 – 100)
  • pCO₂: 46 mmHg (35 – 45)
  • HCO₃⁻: 34 mmol/L (22 – 26)
  • BE: 10 mmol/L (-3 – 3)
  • SaO₂: 100 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 2.7 mmol/L (3.5 – 5.5)
  • Cl: 85 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 4.7 mmol/L (4 – 8)
  • Urea: 9 mmol/L
  • Creatinine: 72 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀

Goblin
Adrenal crisis
The Body Running on Empty

A 32-year-old woman with Addison’s disease presents with vomiting, abdominal pain, hypotension and confusion. She has missed several doses of …

  • ABG
  • pH: 7.28 (7.35 – 7.45)
  • pO₂: 90 mmHg (75 – 100)
  • pCO₂: 28 mmHg (35 – 45)
  • HCO₃⁻: 13 mmol/L (22 – 26)
  • BE: -12 mmol/L (-3 – 3)
  • SaO₂: 98 % (94 – 100)
  • Na⁺: 128 mmol/L (135 – 145)
  • K⁺: 6 mmol/L (3.5 – 5.5)
  • Cl: 103 mmol/L (95 – 110)
  • Ca: 1.17 mmol/L (1.12 – 1.3)
  • Lactate: 2 mmol/L
  • Glucose: 3.4 mmol/L (4 – 8)
  • Urea: 12 mmol/L
  • Creatinine: 120 μmol/L
  • Osmolarity: 280 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀 💀

Goblin
Primary hyperaldosteronism (Conn’s)
The Pressure That Won’t Yield

A 47-year-old man with treatment-resistant hypertension presents with muscle weakness and paraesthesia.

  • VBG
  • pH: 7.5 (7.35 – 7.45)
  • pO₂: 34 mmHg (75 – 100)
  • pCO₂: 42 mmHg (35 – 45)
  • HCO₃⁻: 34 mmol/L (22 – 26)
  • BE: 10 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 146 mmol/L (135 – 145)
  • K⁺: 2.9 mmol/L (3.5 – 5.5)
  • Cl: 96 mmol/L (95 – 110)
  • Ca: 1.2 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 5.5 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 82 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀

Goblin
Cushing’s syndrome with metabolic alkalosis
The Weight of Too Much

A 58-year-old woman with centripetal obesity and hypertension is worked up for suspected Cushing’s and presents with new muscle cramps.

  • VBG
  • pH: 7.52 (7.35 – 7.45)
  • pO₂: 27 mmHg (75 – 100)
  • pCO₂: 45 mmHg (35 – 45)
  • HCO₃⁻: 36 mmol/L (22 – 26)
  • BE: 12 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 142 mmol/L (135 – 145)
  • K⁺: 2.8 mmol/L (3.5 – 5.5)
  • Cl: 90 mmol/L (95 – 110)
  • Ca: 1.22 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 12 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 80 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀

Goblin
Renal tubular acidosis
The Tired Kidneys’ Whisper

A 42-year-old woman with autoimmune disease presents with weakness and vomiting. The GP has been concerned about chronic metabolic acidosis.

  • VBG
  • pH: 7.25 (7.35 – 7.45)
  • pO₂: 31 mmHg (75 – 100)
  • pCO₂: 28 mmHg (35 – 45)
  • HCO₃⁻: 12 mmol/L (22 – 26)
  • BE: -14 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 2.9 mmol/L (3.5 – 5.5)
  • Cl: 110 mmol/L (95 – 110)
  • Ca: 1.15 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 4.8 mmol/L (4 – 8)
  • Urea: 5 mmol/L
  • Creatinine: 75 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Normal saline overload with pulmonary oedema
The Flooded Lungs

A 76-year-old woman with dementia was given 4 L of normal saline for ‘poor urine output’ on the ward and …

  • ABG
  • pH: 7.28 (7.35 – 7.45)
  • pO₂: 60 mmHg (75 – 100)
  • pCO₂: 52 mmHg (35 – 45)
  • HCO₃⁻: 24 mmol/L (22 – 26)
  • BE: -2 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 142 mmol/L (135 – 145)
  • K⁺: 4.1 mmol/L (3.5 – 5.5)
  • Cl: 118 mmol/L (95 – 110)
  • Ca: 1.12 mmol/L (1.12 – 1.3)
  • Lactate: 2.2 mmol/L
  • Glucose: 7 mmol/L (4 – 8)
  • Urea: 9 mmol/L
  • Creatinine: 95 μmol/L
  • Osmolarity: 300 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.4

💀 💀 💀 💀

Goblin
Eating disorder with metabolic alkalosis
The Mirror’s Hidden Cost

A 19-year-old woman with anorexia–bulimia presents with weakness and palpitations after several days of vomiting and laxative use.

  • VBG
  • pH: 7.55 (7.35 – 7.45)
  • pO₂: 52 mmHg (75 – 100)
  • pCO₂: 48 mmHg (35 – 45)
  • HCO₃⁻: 40 mmol/L (22 – 26)
  • BE: 14 mmol/L (-3 – 3)
  • SaO₂: 100 % (94 – 100)
  • Na⁺: 136 mmol/L (135 – 145)
  • K⁺: 2.6 mmol/L (3.5 – 5.5)
  • Cl: 78 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 1 mmol/L
  • Glucose: 4.5 mmol/L (4 – 8)
  • Urea: 8 mmol/L
  • Creatinine: 75 μmol/L
  • Osmolarity: 280 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Simple DKA
The Sweet-Smelling Storm

A 24-year-old woman with type 1 diabetes presents with abdominal pain, polyuria, Kussmaul respirations and fruity breath after missing several …

  • VBG
  • pH: 7.12 (7.35 – 7.45)
  • pO₂: 21 mmHg (75 – 100)
  • pCO₂: 25 mmHg (35 – 45)
  • HCO₃⁻: 8 mmol/L (22 – 26)
  • BE: -18 mmol/L (-3 – 3)
  • SaO₂: 99 % (94 – 100)
  • Na⁺: 128 mmol/L (135 – 145)
  • K⁺: 5.5 mmol/L (3.5 – 5.5)
  • Cl: 96 mmol/L (95 – 110)
  • Ca: 1.16 mmol/L (1.12 – 1.3)
  • Lactate: 3 mmol/L
  • Glucose: 28 mmol/L (4 – 8)
  • Urea: 7 mmol/L
  • Creatinine: 90 μmol/L
  • Osmolarity: 310 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀 💀

Goblin
Panic attack with hyperventilation
The Tingling Rush of Air

A 28-year-old woman presents with sudden onset chest tightness, tingling in her hands and perioral numbness. She is tachypnoeic but …

  • ABG
  • pH: 7.55 (7.35 – 7.45)
  • pO₂: 115 mmHg (75 – 100)
  • pCO₂: 25 mmHg (35 – 45)
  • HCO₃⁻: 22 mmol/L (22 – 26)
  • BE: -1 mmol/L (-3 – 3)
  • SaO₂: 100 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 3.7 mmol/L (3.5 – 5.5)
  • Cl: 104 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 1.2 mmol/L
  • Glucose: 4.8 mmol/L (4 – 8)
  • Urea: 4 mmol/L
  • Creatinine: 65 μmol/L
  • Osmolarity: 285 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀

Goblin
Opioid overdose with respiratory depression
The Slow, Heavy Breaths

A 35-year-old man is found drowsy and hypoventilating after taking a large amount of extended-release morphine. Respiratory rate is 6/min.

  • ABG
  • pH: 7.22 (7.35 – 7.45)
  • pO₂: 50 mmHg (75 – 100)
  • pCO₂: 60 mmHg (35 – 45)
  • HCO₃⁻: 24 mmol/L (22 – 26)
  • BE: -3 mmol/L (-3 – 3)
  • SaO₂: 82 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4 mmol/L (3.5 – 5.5)
  • Cl: 103 mmol/L (95 – 110)
  • Ca: 1.17 mmol/L (1.12 – 1.3)
  • Lactate: 2 mmol/L
  • Glucose: 5.5 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 80 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.21

💀 💀

Goblin
Life-threatening asthma with lactic acidosis
The Silent Chest Returns

A 22-year-old woman with brittle asthma presents in severe distress. She has had continuous salbutamol nebulisers and is now tiring …

  • ABG
  • pH: 7.1 (7.35 – 7.45)
  • pO₂: 55 mmHg (75 – 100)
  • pCO₂: 70 mmHg (35 – 45)
  • HCO₃⁻: 21 mmol/L (22 – 26)
  • BE: -8 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.3 mmol/L (3.5 – 5.5)
  • Cl: 102 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 6 mmol/L
  • Glucose: 9.5 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 80 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.6

💀 💀 💀 💀

Goblin
Severe COPD exacerbation with triple acid–base disorder
The Breath That Wouldn’t Settle

A 72-year-old man with severe COPD on home oxygen presents with increasing dyspnoea. He has been given repeated salbutamol and …

  • ABG
  • pH: 7.3 (7.35 – 7.45)
  • pO₂: 50 mmHg (75 – 100)
  • pCO₂: 75 mmHg (35 – 45)
  • HCO₃⁻: 34 mmol/L (22 – 26)
  • BE: 5 mmol/L (-3 – 3)
  • SaO₂: 86 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.2 mmol/L (3.5 – 5.5)
  • Cl: 90 mmol/L (95 – 110)
  • Ca: 1.12 mmol/L (1.12 – 1.3)
  • Lactate: 4 mmol/L
  • Glucose: 8 mmol/L (4 – 8)
  • Urea: 14 mmol/L
  • Creatinine: 150 μmol/L
  • Osmolarity: 300 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.32

💀 💀 💀 💀 💀

Goblin
SBO with vomiting and aspiration pneumonitis
The Silent Gurgle Turns Sour

A 70-year-old woman with small bowel obstruction has had several days of profuse vomiting and now develops fever, hypoxia and …

  • ABG
  • pH: 7.38 (7.35 – 7.45)
  • pO₂: 68 mmHg (75 – 100)
  • pCO₂: 58 mmHg (35 – 45)
  • HCO₃⁻: 34 mmol/L (22 – 26)
  • BE: 8 mmol/L (-3 – 3)
  • SaO₂: 92 % (94 – 100)
  • Na⁺: 132 mmol/L (135 – 145)
  • K⁺: 2.9 mmol/L (3.5 – 5.5)
  • Cl: 86 mmol/L (95 – 110)
  • Ca: 1.14 mmol/L (1.12 – 1.3)
  • Lactate: 2 mmol/L
  • Glucose: 6 mmol/L (4 – 8)
  • Urea: 9 mmol/L
  • Creatinine: 110 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.4

💀 💀 💀 💀

Goblin
Massive pulmonary embolism with shock
The Collapse at Home

A 64-year-old woman with recent knee replacement collapses at home with sudden pleuritic chest pain, hypotension and tachycardia. She is …

  • ABG
  • pH: 7.2 (7.35 – 7.45)
  • pO₂: 48 mmHg (75 – 100)
  • pCO₂: 55 mmHg (35 – 45)
  • HCO₃⁻: 21 mmol/L (22 – 26)
  • BE: -7 mmol/L (-3 – 3)
  • SaO₂: 82 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.7 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.16 mmol/L (1.12 – 1.3)
  • Lactate: 5 mmol/L
  • Glucose: 7 mmol/L (4 – 8)
  • Urea: 8 mmol/L
  • Creatinine: 95 μmol/L
  • Osmolarity: 295 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.6

💀 💀 💀 💀

Goblin
Blunt chest trauma with shock and saline load
The Road, the Ribs, the Fluids

A 35-year-old driver is intubated after a high-speed MVA with rib fractures, pulmonary contusions and hypotension. He has received 3 …

  • ABG
  • pH: 7.08 (7.35 – 7.45)
  • pO₂: 65 mmHg (75 – 100)
  • pCO₂: 55 mmHg (35 – 45)
  • HCO₃⁻: 16 mmol/L (22 – 26)
  • BE: -14 mmol/L (-3 – 3)
  • SaO₂: 90 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.6 mmol/L (3.5 – 5.5)
  • Cl: 118 mmol/L (95 – 110)
  • Ca: 1.1 mmol/L (1.12 – 1.3)
  • Lactate: 8 mmol/L
  • Glucose: 10 mmol/L (4 – 8)
  • Urea: 6 mmol/L
  • Creatinine: 90 μmol/L
  • Osmolarity: 300 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 1

💀 💀 💀 💀 💀

Goblin
Paediatric anaphylaxis with shock
The Cookie at the Party

An 8-year-old girl with peanut allergy presents with facial swelling, wheeze, hypotension and reduced level of consciousness after eating a …

  • ABG
  • pH: 7.12 (7.35 – 7.45)
  • pO₂: 60 mmHg (75 – 100)
  • pCO₂: 60 mmHg (35 – 45)
  • HCO₃⁻: 18 mmol/L (22 – 26)
  • BE: -10 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 138 mmol/L (135 – 145)
  • K⁺: 4.5 mmol/L (3.5 – 5.5)
  • Cl: 100 mmol/L (95 – 110)
  • Ca: 1.18 mmol/L (1.12 – 1.3)
  • Lactate: 6 mmol/L
  • Glucose: 9 mmol/L (4 – 8)
  • Urea: 5 mmol/L
  • Creatinine: 40 μmol/L
  • Osmolarity: 290 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.6

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Goblin
CCF + COPD + CKD on diuretics
The Breathless Balancing Act

A 78-year-old man with known COPD, chronic kidney disease and heart failure on frusemide presents with worsening dyspnoea, orthopnoea and …

  • ABG
  • pH: 7.37 (7.35 – 7.45)
  • pO₂: 55 mmHg (75 – 100)
  • pCO₂: 60 mmHg (35 – 45)
  • HCO₃⁻: 34 mmol/L (22 – 26)
  • BE: 8 mmol/L (-3 – 3)
  • SaO₂: 88 % (94 – 100)
  • Na⁺: 140 mmol/L (135 – 145)
  • K⁺: 4.8 mmol/L (3.5 – 5.5)
  • Cl: 90 mmol/L (95 – 110)
  • Ca: 1.12 mmol/L (1.12 – 1.3)
  • Lactate: 3 mmol/L
  • Glucose: 7.5 mmol/L (4 – 8)
  • Urea: 25 mmol/L
  • Creatinine: 250 μmol/L
  • Osmolarity: 305 mOsm/L
  • COHb: 1 % (0.2 – 2)
  • MetHb: 1 %
  • fiO2: 0.28

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Project information

⚠️ Blood gas analysers often output raw numbers and leave us to mentally run the labyrinth of equations and pattern-recognition steps each time. This post-nights project was built out of frustration with the gap between this laborious (and potentially-error-prone) practice and modern resuscitation principles (cognitive offloading, human-factors), and then it evolved into a bit more of a walkthrough quiz/teaching tool from there.

Understanding the calculations (e.g. Winter’s formula, anion gap, delta gap, expected compensation) is important, but in busy clinical settings we need tools that lighten cognitive load.

⚠️ TRAINING TOOLS ONLY - NOT FOR CLINICAL USE ⚠️