A 29 year old female presents unwell with hypotension, tachycardia and tachypnoea.
Her blood results indicate:Severe metabolic acidosis
High anion gap acidosis with normal renal function, lactate but high glucose and ketones
delta ratio of 0.65, which indicates an additional non anion gap metabolic acidosis, with elevated chloride
Management is aimed at fluid replacement – limit normal saline use as the chloride will exacerbate the acidosis
electrolyte monitoring and replacement
with investigation and treatment of cause of illness