A 10 year old obese female with abdominal pain, who is unwell requiring resuscitation. She is hypotensive, tachycardic and hypothermic suggesting severe sepsis.
Uncompensated (normal CO2 – even though venous) high anion gap (17) metabolic acidosis
Delta gap – 0.8 => likely pure HAGMA especially with elevated lactate
Renal failure – ?pre renal due to dehydration, supported by high lactate
Elevated glucose – consider DKA (this patients ketones were negative and glucose not high enough for typical DKA)
Abnormal liver function suggesting biliary obstruction
Very high Lipase
These blood in the setting of abdominal and sepsis suggest gallstone pancreatitis, Cholecystitis. Unlikely to be due to DKA.
Gen surg consult