55 year old female – AMS

VBG shows:

1. Severe hyponatraemic, hypokalaemic, hypochloraemic metabolic alkalosis

compensated (within limitations of VBG)

Elevated lactate

AG = 6 (low –>?? alcohol)

2. AMS – seizure, trauma, alcohol intoxication/withdrawal/ Wernicke’s, severe hyponatraemia, sepsis (intracranial/ other), drugs/ toxins, CVA etc

3.A, B, C approach

Seek and treat cause

Normal glucose

3% saline for rapid elevation of Na, to prevent further seizures – 100ml

correct electrolytes