A 2 month old female presents in extremis. Her blood results show:Severe life threatening mixed HAGMA and Respiratory acidosis (normal CO2 despite tachypnoea) with severe hyperlactataemia and elevated glucose.

Delta ratio = 0.6

Possible triple acid base disorder – additional NAGMA

Causes to consider:

Severe sepsis and septic shock

DKA

Inborn errors of metabolism

cardiac failure

Intestinal catastrophy (ischaemic gut/ perforation/ obstruction)

She requires urgent resuscitation – O2 support, ivi fluids, antibiotics, consider steroids

Consider airway support, including intubation with care and advice from Paediatric ICU, ??digoxin/ diuresis

Disposition to tertiary centre ICU urgently