A 2-year old male presents with febrile seizure lasting ~10 minutes.

10 minutes after cessation IV access is established and a VBG is taken

Results:

• pH: 7.28 (Reference range: 7.31 – 7.41)
• pCO2: 60 mmHg (Reference range: 35 – 45 mmHg)
• HCO3: 18 mmol/L (Reference range: 22 – 29 mmol/L)
• Base Excess: -8 mmol/L (Reference range: -3 to +3 mmol/L)
• Lactate: 7.0 mmol/L (Reference range: 0.5 – 2.2 mmol/L)
• Sodium: 146 mmol/L (Reference range: 135 – 145 mmol/L)
• Chloride: 108 mmol/L (Reference range: 98 – 107 mmol/L)
• Glucose: 5.5 mmol/L (Reference range: 3.9 – 7.8 mmol/L)

What does this blood gas show?

• Acidaemia
• Respiratory and Metabolic acidoses
• Anion Gap 20
• Delta Gap 1.8
• ==> Pure HAGMA plus respiratory acidosis secondary to seizure