A 30 year old alcoholic presents with reduced oral intake and vomiting.

Her blood results indicate:mild acidosis – triple acid base disorder

AG 19 which is slightly elevated, with increased ketones

compensation – additional respiratory acidosis

delta ratio of 0.5 – additional non anion gap with elevated chloride

mild hypokalaemia

elevated lipase – ??chronic/ acute on chronic pancreatitis

Starvation keto acidosis/ alcoholic ketoacidosis – requires Insulin/ dextrose infusion to correct acid base disorder.