A 69 year old with type 1 respiratory failure Compensated NAGMA – ? secondary to N/saline administration (hyperchloraemia)

Severe hypoxia with very large A-a gradient (500+) due to VQ mismatch/ shunt/diffusion defect. Possible PE/ severe pneumonia/COPD/ARDS/severe ILD

Elevated glucose and mild increase in lactate

Check ketones, exclude DKA