A 77 year old female with severe metabolic derangement following bout of vomitingThe blood results show:

Severe life threatening HAGMA

partially compensated or additional respiratory acidosis

Elevated delta ratio (1.6) – explained by lactate, which will usually give you an AG of 1.6

life threatening hyperkalaemia (actual K closer to 5.5)

massive elevation of lactate

Summary:

Severe: HAGMA  and possible underlying respiratory acidosis. Severe volume depletion with loss of gastric acid and altered mental state or possible pre existing CO2 retention with metabolic compensation.

Must check: ECG, BSL, renal function

Treatment is aimed at resuscitation, cardiac protection, treatment of hyperkalaemia and consideration of dialysis based on K and renal function. Look for underlying cause of symptoms.