A 45 year old female presents critically unwell with altered mental state and shockHer GCS is: 7

E  1

M  4

V  2

HHS – osmolality = 325

consider DKA (any implications with immediate treatment regime?)

HAGMA (AG = 27)

Renal failure – likely pre renal as urea relatively higher than Creat

Total body depletion of K

Additional NAGMA (delta ratio 0.7)

Appropriate CO2 compensation

Approach:

Resuscitate – aim for MAP 60+ prior to induction

Intubate and hyperventilate (to maintain compensation)

Investigate

ICU