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?
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