27 year old with GCS 7 but haemodynamically stable presents with severe HAGMA, appropriately compensated

delta gap – pure HAGMA

renal failure – Creatinine high

mild elevated K but total body K low (shift from acidosis)

Aa gradient: assume max O2 delivery with Hudson at 8 litres about 60% is elevated – VQ mismatch/shunt/diffusion defect (pneumonia/PE/inhalation/aspiration etc)

Go through causes of HAGMA and exclude

ketones

lactate, sepsis

renal failure

toxins