1. Describe and give the likely cause

Uncompensated high anion gap metabolic acidosis with hyperglycaemia and high lactate, due to diabetic ketoacidosis with shock and peripheral hypoperfusion

2. Describe the Potassium

Normal Potassium level reflecting total body depletion due to:

a. acidosis causing shift from intra to extra cellular spaces

b. Osmotic diuresis which causes loss of Potassium from the kidneys

Every 0.1 reduction in pH causes shift (loss) of 0.5 mmol/L of Potassium, this patients true Potassium likely to be around 3.0 mmol/L once correction of acidosis occurs

3. Commonest causes

Infection

New onset Insulin dependant diabetes

Non compliance with medication

4. Diagnostic Criteria

ketonuria/ ketonaemia

Glucose >13.9 mmol/L

pH < 7.3

5. Treatment aims:

Fluid Resuscitation

Replenish electrolytes and volume losses (check K prior to Insulin administration)

Reverse acidosis and ketosis

Reduce glucose to normal

Identify and treat underlying cause

6. Mortality

hypokalaemia

cerebral oedema

ARDS

Death due to underlying cause eg. pneumonia, acute myocardial infarction