Lab Case 62 – Interpretation

Unwell patient with weakness presents with:


Compensated anion gap metabolic acidosis (AG 34)

Additional metabolic alkalosis (Delta gap >2)



renal failure

Evidence of infection

elevated lactate – hypoperfusion, shock


Starvation causing ketosis and hypoglycaemia

Gastroenteritis – vomiting with loss of HCl

Causes of AG in this patient include renal failure, starvation ketoacidosis, sepsis, high lactate


Management of this patient includes fluid therapy, correcting hypoglycaemia in the first instance and then Insulin/dextrose infusion until ketosis resolves. Care must be taken to avoid further hypoglycaemia.

Identify source of sepsis and treat – possible GI in this patient, consider General Surgical review.

Treatment of ketoacidosis should aim for the following:

  • Fluid resuscitation
  • Reversal of the acidosis and ketosis
  • Reduction in the plasma glucose concentration to normal
  • Replenishment of electrolyte and volume losses
  • Identification the underlying cause