Lab Case 82 – Interpretation

39 year old man presents with life threatening illness

  1. High anion gap metabolic acidosis – with high BSL, lactate, normal creatinine – likely DKA

Winter’s: expected CO2 12.5, actual 17.7 – uncompensated, in the context of altered mental state likely additional respiratory acidosis

Delta ratio = 0.76, close to 0.8 so likely pure HAGMA

Corrected Na = 136, normal

Corrected K = 2.5 mmol of shift, actual K 3.4 with total body K depletion => care when starting Insulin, will require K supplementation

Lactate – shock, sepsis etc

2. Airway/ Breathing issues:

Likely to require intubation:

Reusc bay with adequate experienced staff

Experienced person to intubate, not  a teaching case

Drugs

  • haemodynamic status – cardiostable drug dosage
  • paralytic – sux vs roc
  • low pH – dependant on high resp rate – risk of arrest on paralysis
  • First time pass on intubation
  • consider HCO3 as adjunct prior to paralysis
  • hyperventialton on ventilation
  • etc, etc
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