A 26 year old man presents with a febrile illness and vomiting. He is unwell, with low BP and tachycardiaTriple acid base disorder

HAGMA (AG 27)

Additional respiratory alkalosis (expected 35, actual 24)

Additional metabolic alkalosis (Delta ratio 2.5)

with hyponatraemia, hypochloraemia from vomiting

and renal failure/ haemoconcentration from severe dehydration

possible additional infection

Treatment is fluid, fluid, fluid – repeat bloods, treat infection(if present), rpt bloods to ensure renal function improves

In this patient, information regarding marijuana abuse, refer to drug and alcohol

This patient recovered with 4 litres normal saline and was discharged home a few hours later.