A 68 year old female present with altered mental state, shock and hypothermiaHer blood test shows severe life threatening high anion gap metabolic acidosis with high osmolality with additional respiratory acidosis

whole body depletion of Potassium

check ketones

Reasons for acidosis: HHS, DKA, renal failure, sepsis, hypoventilation

look for precipitating causes for hyperosmolar state – sepsis, CVA, IHD etc

requires resuscitation, intubation