A 55 year old female with type 2 Diabetes is brought to your ED by ambulance. She has been unwell for two weeks with vomiting and diarrhoea. Her past medical history includes 3 MI’s, early COPD, HTN and high cholesterol.

Vital Signs:

BP 94 systolic

PR 104/min

RR 22

Sats 92RA

Describe and Interpret

pH 7.2 (7.36-7.44)

pCO2 38 (36-44mmHg)

HCO3 15 (20-26 mmol/l)

BE -12 (-2-4)

Sodium 119 (136-145 mmol/l)

Potassium 5.9 (3.4-4.5 mmol/l)

Chloride 90 (98-111 mmol/l)

Urea 15 (3-8 mmol/l)

Creat 55 (30-100 umol/l)

Glucose 50 (3-8 mmol/l)

Lactate 2.6 (<1.5)

WCC 21.7 (4-11)

What investigations would you do?

Thanks to Setu for this great case.