44 year old critically unwell man with low GCS and severe hypothermia

1. Severe high anion gap metabolic acidosis with additional respiratory acidosis

severe hyperkalaemia – must be urgently addressed

high lactate

renal failure

severe transaminitis

1. Causes to consider:

shock and hypoperfusion

Sepsis

trauma

Diabetic Ketoacidosis – check ketones, BSL

drug overdose – paracetamol toxicity, other

CNS catastrophy

Aspiration and hypoventilation

Also, consider rhabdomyolysis as a cause of renal failure, hyperkalaemia and elevated lactate

1. Immediate life threats include

arrhythmia from hyperkalaemia and hypothermia

severe acidosis

shock

Aspiration with deterioration of respiratory status

1. Attention to A, B, C:

oxygenation, care with excessive movement of the patient

Prepare for RSI – requires experienced operator, safe drug regimen, consider delay until patient warmer

Fluid, inotropes – care with central venous access

Antibiotics

Consider NAC infusion

Early ICU Consultant review – ?haemodialysis to warm patient