Critically unwell patient in shock requiring immediate resuscitation and further investigation of underlying illness.
Triple disorder (normal pH)
1. Hypokalaemic hypochloraemic metabolic alkalosis – classically occurs with gastric outlet obstruction
This patient had a gastric outlet tumour causing obstruction
Consider other causes of metabolic alkalosis
2. Respiratory acidosis – likely COPD (chronic CO2 retention)
Consider aspiration, pneumonia, other
compensation for metabolic alkalosis – 0.7XHCO3+20 = 48 (actual 63)
3. High anion gap metabolic acidosis
shock, sepsis, renal failure, other
Anion Gap = 19
Other relevant results – renal failure (pre renal – urea >> Creatinine and renal component), moderate to severe hypokalaemia (requires replacement), high WCC and Neutrophils (sepsis), high lactate (sepsis, dehydration)