32 years old aboriginal woman presents to ED with lethargy. She is previously well, and has not seen any medical services in last 10 years. Her VBG  results are as followed:

PH                                   7.25

PCO2                               25

HCO3                              11.7

Hb                                    81

Na                                   140

K                                     5.1

Ca                                   0.81

Cl                                    98

Glu                                 9.6

Lac                                 0.9

Answers:

1.  PH 7.25 (  acidemia ), metabolic ( HCO3  11.7),  AG=  ( 140+5.1 – 11.7 + 98) = 35.4 , Expecetd CO2= 1.5 X 11.7 + 8 =  25.5, so it is fully compensated High Anion gap metabolic acidosis.

Mild hyperkalemia secondary to ? Renal failure / artifactual

Mild Hyperglycaemia ( ?untreated DM).

Hypocalcaemia from ? renal failure.

Anaemia > secondary to renal failure / acute blood loss.

2.        Diabetes induced nephropathy

Post streptococcal glomerulonephritis, other nephritis.

Other causes of ARF.

3.     Symptomatic Treatment :

Fluid administration if clinically dehydrated, or oliguria. IDC to monitor urine output. Glucose control.

Definitive: Preparation for dialysis. Renal/ ICU team need to be liaised. Needs placement of vas cath.