History – V, D, abdo pain –> consider DDX – Gastroenteritis,
Surgical causes (cholecysttis, pancreatitis, other), Medical causes ( DKA, other)
Vitals – hypotensive, bradycardia –> fluid depletion, electrolyte abnormalities, cardiac Ischaemia, other..
Two major abnormalities
1. Severe hypokalaemia requiring immediate replacement. Replace Mg (aim for Mg >1)- see comment by Ken in ECG of the week. Urgent ECG for changes.
2. High Lipase indicating Pancreatitis (Lipase level is not an indication of severity). Remember to look for causes – alcohol, gallstones (normal LFT here) etc
high WCC and Neutrophil count – necrotising pancreatitis, other sources of sepsis
mildly elevated CL and low HCO3 – hyperchloraemic acidosis –> normal saline rehydration, sepsis, pancreatitis etc.
Immediate priorities include :
Replace Potassium and Magnesium
Cardiac/ ECG monitoring
HDU consult – large amounts of Potassium may be required via central access
Gen surgery review +- CT abdomen
This patient should not go to a ward unmonitored unless the Potassium has been addressed and the ECG and K level is normal.
So… why all these bloods?
Remember Ranson’s criteria
Hct drop of >10%
Urea increase >1.8
BE > -4
fluid sequestration > 6litres
This one is for alcohol aetiology, there is a slightly different one for gallstones.
Score >2 is severe
0-2 2% mortality
other scoring systems to be familiar with include…