Introduction: Ketoacidosis is commonly occurred in uncontrolled diabetes mellitus patients. However, severe Metabolic acidosis due to starvation is rarely reported in literature. We describe a case of ketoacidosis in a 27-year old pregnant female at week 30 of gestation, with normal former pregnancy.She was admitted to hospital with a 24-hour history of vomiting (more than 30 times in a day). There was no additional pain or symptoms.Case Report: On admission, she was normotensive.Blood glucose was 111 mg/dL, serum creatinine0.6 mg/dL, and urine dipstick showed acetone (3+) without Proteinuria. Urine pH was 6. Blood gas analysis showed severe Metabolic acidosis with a PH of 7.24 (HCO3- 7.9 meq/L, BE -14, PCO2 15.2 mmHg, PO2 72 mmHg). Then, we checked serum electrolytes. Serum chloride was 102 mg/ dL, Na=135 meq/L, K=5 meq/L. Based on these data, there was high anion gap Metabolic acidosis in patient. After 3 days hydration with dextrose in saline, gradually blood gas improved as on discharge it showed pH 7.44, PCO2=44 mmHg, HCO3-=28 meq/L, and her vomiting had been disappeared.Conclusions: We conclude that in this case acidosis was due to starvation and inhibition of insulin secretion that led to ketone production. After correction of dehydration by glucose replacement, she was improved and discharged.

Objective: To assess changes in blood gas parameters, such as pH, partial carbon dioxide pressure (PaCO2), bicarbonate (HCO3), base deficit, and lactate values, in patients who present to the emergency care unit after a seizure. Methods: This is a prospective study on patients who suffered a generalized tonic-clonic seizure. The demographic and biochemical data of the patients and their blood gas parameters were recorded both at the time of presentation to the emergency department and during the follow-up examination. Results: A total of 68 patientswere included in the study. Among the patients, 60. 3% (41)were male. The median age of the patients was 43 years (IQR: 29-65. 25). The median initial lactate value was 5. 7mmol/L (25th and 75th percentiles: 3. 5–, 8. 5 mmol/L). The median follow-up lactate value was 1. 8 mmol/L (25th and 75th percentiles: 1. 1–, 2. 8 mmol/L). The statistical analysis of the blood gas parameters revealed a statistically significant difference in the pH, PaCO2, base deficit, and lactate values between the initial and follow-up evaluations (P<0. 001). Conclusion: The results of our study suggest that Metabolic acidosis with high anion gap may develop due to the increase in the lactate levels as a result of a tonic-clonic seizure.

Objective: In this study, we evaluated the predictive factors for the occurrence of Metabolic acidosis in patients with multi‑, drug poisoning, including antidepressants (Ad)/antipsychotics (Ap). Methods: This cross‑, sectional study was carried out in the referral poisoning center, Khorshid University Hospital, affiliated with Isfahan University of Medical Sciences. All patients with multi‑, drug ingestion, including Ad/Ap, were included in the study. Patients were divided into two groups with and without Metabolic acidosis. Demographic factors, time from ingestion to admission, clinical manifestations, length of hospital stay, and outcome were compared in two groups. Binary logistic regression was used to identify factors associated with the risk of Metabolic acidosis occurrence. Findings: Among the 206 evaluated patients, 45 patients (21. 8%) had Metabolic acidosis whom the majority were female (73. 3%) with intentional purposes (77. 8%). 31. 1% of the patients with Metabolic acidosis had tachycardia on admission (P = 0. 03). Among all variables, time from ingestion to admission (P = 0. 02) and lengths of hospital stay (P = 0. 002) were significantly different between patients with and without Metabolic acidosis. Tachycardia on admission (adjusted odds ratio [OR], 2. 24,95% confidence interval [CI]: 1. 05–, 4. 76,P = 0. 036) and time from ingestion to admission (adjusted OR, 1. 06,95% CI: 1. 00–, 1. 13,P = 0. 04) were also the predictive factors in occurrence of Metabolic acidosis. Most of the patients survived without any complications (94. 6%), of whom 72. 3% had no previous underlying somatic diseases (P = 0. 05). Conclusion: Admission tachycardia and the time elapsed from ingestion to admission may be considered important factors for predicting Metabolic acidosis in multi‑, drug poisoning, including Ad/Ap.

Background: Metabolic acidosis (MA) is a common pathologic process with fatal consequences in critically ill (CI) patients. The more the severity of acidosis the more mortality rate is expected. To evaluate the relationship of hospital mortality with MA severity in CI patients admitted to emergency department (ED). Methods: In this prospective cohort study, we enrolled CI patients (based on physician clinical assumption), most at level 1 or 2 emergency severity index triage system. Patients were followed and evaluated in 2 parallel groups, one with and the other without MA. The severity of acidosis, chief complaints, final diagnosis, demographic data, acute physiologic assessment and chronic health evaluation II (APACHE II) score, serum lactate and bicarbonate level, need for intubation and mechanical ventilation, admission ward, hospital length of stay and in hospital mortality were compared between the 2 groups. Results: A total of 1811 CI patients including 60.2% males and 39.8% females with and without MA were evaluated. The most common age range was 65-55 years old (31.7%) with the meanSD of 61.348.23. The most common complaints and diagnoses were weakness (40.5%) and pneumosepsis (35.1%), respectively. Patients with severe acidosis had higher lactate level and APACHE II score (p<0.05). Mortality rate was 10.4%. Most of our cases had severe MA. Expired cases had higher lactate level and APACHE II score (p<0.05). Conclusion: Lactate level, bicarbonate level and APACHE II score were all significant independent predictors of hospital mortality in CI patients.

Background: Rice Tablet, with the scientific chemical name of aluminum phosphide (ALP), is the most common pesticides and insecticides agent in agriculture, horticulture and is used to protect beans, cereals, and rice. Poisoning with this tablet is associated with a high mortality rate. The aim of this study was to evaluate patients who committed suicide with rice tablets and referred to Sina Hospital, Tabriz, during the years 2011-2015.Methods: In a routine data base study that was conducted at Sina Hospital affiliated to Tabriz University of Medical Sciences, medical records of patients with suicide attempt with rice tablets during the years 2011-2015 were evaluated. During the mentioned period, 90 patients with rice tablet poisoning were admitted to the hospital. The required information was recorded in the check list.Results: Out of 90 patients, 72 patients (80%) had ALP tablets poisoning. The mean age of subjects was 27.52±0.13 years. In patients with ALP poisoning, the mean of mean arterial pressure (MAP), serum pH, serum bicarbonate, and arterial oxygen saturation between two groups (with or without mortality) were statistically significant (P value˂0.001). All variables are related to admission time in the emergency department. To determine the prognostic value of these variables in predicting mortality in patients with ALP poisoning logistic regression was used and only serum bicarbonate can predict mortality with P value=0.011.Conclusion: The results of the current study show that the survival of patients with ALP poisoning is associated with MAP, pH, and serum HCo3, arterial blood oxygen saturation at the time of admission in the emergency department. Next prospective studies are recommended for more accurate evaluation of the effect of these variables on the patients' survival.

Background: Metabolic acidosis is a fatal finding in trauma patients that complicates the process of resuscitation.Case: The case was a 37-year-old man with open fracture in both legs and fracture in second lumbar vertebral (L2). The serial arterial blood gas (ABG) test results showed a pH value of 6.7 indicating a very severe and special case of Metabolic acidosis. The rate of mortality for such a case was very high. The patient was treated with sodium bicarbonate and successfully revived after four hours post treatment and Metabolic acidosis was resolved.Conclusion: This indicated that bicarbonate administration is useful for very severe cases. The good condition of the patient after survival from the severe academia allowed for extubation.