Lab Case 59 – Interpretation

68 year old man, critically unwell, shocked with severe respiratory failure.


Mixed mild normal anion gap metabolic acidosis and severe respiratory acidosis

Also, likely to have anion gap metabolic acidosis – renal failure and lactic acidosis

?spuriously high HCO3 – attempted compensation for respiratory acidosis

severe hyperkalaemia requiring urgent reduction to prevent arrhythmia, with acute renal failure (??acute on chronic)

Elevated troponin

mild hyponatraemia – corrected is normal

HHS – osmolality > 320, normal anion gap


Severe shock with multiorgan failure

Possible sepsis, NSTEMI, abdominal cause


Respiratory failure

3. Treat hyperkalaemia

Resuscitate, likely to have a significant fluid deficit

Ventilatory support

Treat cause