78 years old female is brought to ED by her daughter with complaint of increasing lethargy, confusion for last few days.
She has been vomiting intermittently for last 3 days . No diarrhoea, no fever. Her oral intake is reduced but she has been compliant with her medications. she has background of atrial fibrillation, T2 DM, HTN, and increased cholesterol.
OE : GCS 13-14. Pupils equal reactive, CT Head normal. HR35- 38, BP 109/70, afebrile, RR 22, sats 95 RA. Her Venous blood as is as followed.
PH 7.30
HCO3 22
PCO2 40
Na 141
K 5.7
Lactate 2.7
BSL 6.7
Cl 95
Questions:
- What are the main abnormalities on this VBG? what is the underlying metabolic disorder?
2. On further collateral she is known to be on digoxin for Atrial fibrillation, and ECG shows atrial fibrillation with slow ventricular response. what further investigations you would like to do ??
3. How will you treat above patient?