A 72 year old female presents generally unwell with low BP and low grade tachycardia.

her blood results show:Metabolic alkalosis with mild hyponatraemia/ hypochloraemia and moderate hyperkalaemia and additional respiratory acidosis.

There is also an additional metabolic acidosis  (Lactate 2)

Consider:

dehydration/ vomiting

endocrine – Addison’s

Diuretics

with additional sepsis/ intracranial abnormality

Requires:

resuscitation – fluid

Search for underlying cause, including septic screen/?CT head etc.

Endocrine screening prior to administration of steroids for refractory hypotension. Steroid of choice is hydrocortisone, while dexamethasone is least recommended.