A 57 year old lady presents unwell with abdominal pain and vomiting.
Her blood results show:Severe HAGMA = AG 26
Partial compensation, expected CO2 = 19
additional NAGMA = hyperchloraemia
Delta ratio – 0.8
Mild elevation in glucose
Severe DKA with relative normoglycaemia or hypoglycaemia – occurs in setting of SGLT II inhibitors (Jaridamet is a combination of Metformin and SGLT II inhibitor).
Abdominal pain – likely due to DKA but exclude abdominal causes
Treat as per DKA protocol