A Case Report of a Patient Surviving Severe Acidemia With Arterial pH Less Than 6.5

Surviving an arterial pH below 6.5 is exceedingly rare due to significant disruption of processes at the cellular level. We report a case of a 25-year-old female with altered mental status, hypotension, and refractory metabolic acidosis. Initial arterial blood gases were unreadable, but aggressive sodium bicarbonate therapy revealed an arterial pH of 6.62. Suspected ethylene glycol poisoning led to aggressive bicarbonate replacement, fomepizole therapy, and emergent hemodialysis. The patient showed rapid clinical recovery and was discharged from the hospital after six days, demonstrating that recovery is possible with appropriate, timely care even at potentially fatal arterial pH levels.