A 17 year old male presents potentially seriously unwell

1. Abnormalities:

Primary Respiratory alkalosis –

Lactic acidosis – sepsis, dehydration

Possible metabolic alkalosis due to vomting

Severe hypokalaemia – diarrhoea (loss) and alkalosis (shift)

normal BE

2. Hyperventialtion – consider central (raised ICP/ cerebral irritation/ central stimulation)

causes: Meningitis, ICH, Mass lesion, CVA, drugs (Salicylates) etc

other – Respiratory – Pneumothorax, PE, pneumonia –

unlikely in this patient – no respiratory complaints

The metabolic component may co exist thus making the HCO3 normal

3. Priorities:

Resuscitation – A, B, C

Replace K

Consider early antibiotics

4. Tests

CT (if no temperature

LP

This patient had meningitis, was admitted to ICU and eventually discharged after 1 week.