A 70 year old female presents to ED with a 1 month history of vomiting and diarrhoea.
Over the last few days she has started to feel increasingly weak and had a few episodes of confusion. The patient has a background history of one previous episode small bowel colitis for which she was treated with a short course of steroids 2 years ago. On examination HR 102 BP 90/540 Apyrexial Sats 97% RA RR18. She has dry mucous membranes and decreased skin turgor and CPR 3 seconds.
pH 7.557 Na 122 mmol/l
pCO2 44 mmHg K 2.0 mmol/l
HCO3 37 mmol/l Cl 74 mmol/l
BE 12.9 Cr 85 umol/l
Lactate 2.6 BSL 5.5 mmol/l
- Describe and interpret the VBG
- What are the likely causes of low sodium in this case?
- How would you manage this patients fluid replacement?