this case illustrates the importance of the clinical history in accurate interpretation of the case. the electrolytes and creatinine are also important factors in diagnosing a triple acid-base disorder of respiratory alkalosis (from hyperventilation), metabolic alkalosis (from vomiting), and metabolic acidosis (probably from congestive heart failure). a nomogram such as figure 1-3 cannot be used. the following table shows both the clinical picture and the laboratory results that support this dianosis