A 24 year old female presents with vomiting and abdominal pain. She is drowsy, febrile and pale.
Vital signs:
BP 90 systolic
HR 120/min
T 38
RR 26/min
After initial resuscitation her blood gas is as follows:pH 6.99
pCO2 22
HCO3 5
BE -26
Na 139
K 5.2
Cl 114
Creat 64
Hb 143
Lactate 3.4
Describe and interpret the VBG
HAGMA. Lactate alone does not explain derangement. Would like to see glucose level to establish if DKA. Could be sepsis driving DKA, which explains the fever, lactate and the derangements. Creatinine normal but would follow closely with urine output to see if acute kidney injury a component. Lastly, measure and calculate osmolality – high osmolar gap suggestive of toxins (salycilates, etyhlene glycol, methanol).