A 2 year old boy is brought in to your ED by his mum who complains that her child has been drowsy and irritable for the past two days. He has multiple allergies and cannot take any dairy products due to rashes and diarrhoea. She has been using other milk substitutes to feed her child.

On examination the child looks pale, floppy, irritable and unwell.

Vital signs:

BP 75/45

PR 150/min

RR 55/min

Temp  37 degrees

His blood results show:

pH  7.15

pCO2  30 mmHg   (35-45)

HCO3   12 mmol/l   (22-26)

Na   142   mmol/l    (137-145)

K    3.5   mmol/l    (3.5-5)

Cl     100   mmol/l   (99-111)

Glucose   5.5   mmol/l   (4-6)

Lactate     5   mmol/l     (<2)

Ketones    weakly positive

Urea     12   mmol/l  (3-8)

Creat    100  umol/l   (<130)

WCC    12  (4-11)

Nuetrophils   7   (4-7)

CRP   15

1. Describe the abnormalities.

2. What are the appropriate calculations?

3. List the possible causes, and the most likely cause

4. What are your treatment priorities?

Thank you Claire McQuillan