Lab Case 133

A 30 year old patient with a history of recurrent pancreatitis and chronic alcoholism presents to your ED with reduced oral intake, vomiting and shivering.

Her blood results:pH  7.257

pCO2  48  (35-45  mmHg)

HCO3   9.9  (22-26  mmol/l)

Hb   158

Na  138  (137-145  mmol/l)

K     3.9  (3.5-5  mmol/l)

Cl     103   (99-111  mmol/l)

Glu    8.1   (4-6  mmol/l)

Lactate   1.4

Creat   50  (<130  umol/l)

Ketones  6

Lipase 217

Describe and interpret the blood tests

How would you treat her?

 

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  1. She has a mixed acidosis (HAGMA and NAGMA). Winter’s formula would suggest it is not adequately compensated (there is a relative respiratory acidosis)…

    So you need to go looking for the cause of a three problems

    Ketones are up, so likely dehydrated – so some fluids, urine output monitor, then serial gases. Avoid saline, maybe hartmann’s or plasmalyte as perhaps the 3rd space loss, fistula, diarrhoea or a RTA has put up the chloride relative to the low bicarbonate.

    Screen for sepsis

    GIve some thiamine

    If she has chronic pancreatitis could consider screening with CT for complications such as pseudocysts.

    Call surgeons

    Admit to HDU

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