27 year old with weakness presents with…

alkalaemia

metabolic – very high HCO3

Respiratory compensation is adequate  (expected CO2 48, actual 52)

normal anion gap

severe hpokalaemia and moderate hypochloraemia

Normal glucose and lactate

Interpretation:

Compenasted metabolic alkalosis with severe hypokalaemia and moderate hypochloraemia

Causes to consider include:

Severe vomitting/ diarrhoea with dehydration (lacate normal)

Endocrine disorders – Conn’s (hypokalaemia, but sodium normal) or Cushing’s (usually hyperkalaemic)

Liqourice/ diuretic intoxication/ abuse

antacid/ alkali abuse

Other – unlikely in this patient – refeeding syndromes, post hyperventilation

2. ECG changes – see John’s blog from this week (29/9/15)

hypokalaemia is an ischaemia mimic

Note the ST depression, down up T waves

prominent U waves