A 64 year old critically unwell female requiring immediate resuscitation
- Mixed HAGMA, respiratory acidosis and possible NAGMA – triple acid base disorder
Anion Gap = 22
Delta ratio = 0.625
Mild hyponatraemia
Severe hyperkalaemia
Severe lactate acidosis
Acute renal failure
Obstructive jaundice – ??Ascending Cholangitis
elevated Troponin – ??AMI
Interpretation:
Sepsis
Shock – septic, hypovolaemic, cardiogenic, ??obstructive
consider causes of HAGMA, Resp acidosis and NAGMA
??haemolysed sample – check ECG and repeat/ treat as high
Delta ratio suggests additional NAGMA but is often <1 in renal failure
- MELAS
Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS) syndrome is a progressive neurodegenerative disorder.
Sporadic or maternal transmission
Other features, such as seizures, diabetes mellitus, hearing loss, cardiac disease, short stature, endocrinopathies, exercise intolerance, and neuropsychiatric dysfunction are also part of the disorder.
80% of patients have a mutation in tRNA at base pair 3243 A-G mutation
- Resuscitate
Treat K
Antibiotics
Inotropes
End of life care issues