A critically unwell 70 year old man.

His blood results show:

High anion gap metabolic acidosis with elevated glucose, lactate and renal failure

Uncompensated/ likely additional respiratory acidosis

Very high A-a gradient (VQ mismatch, shunt, diffusion defect)

Severe hypoxia

Acute renal failure with severe hyperkalaemia

Pseudohyponatraemia

Elevated sepsis markers – WCC, N, CRP

Troponin leak

Shock – elevated lactate (high associated mortality)

2. Causes:

DKA

Sepsis

Acute renal failure – severe volume depletion, possible ATN

Critical illness, renal failure – elevated troponin (check ECG)

Respiratory trigger – pneumonia, PE, pneumothorax

Concentration effect on WCC, N, Hb, Platelets – assess for possible sites of occult blood loss or chronic disease related.

3. Priorities

Correct K

ABC approach

– Oxygen as given, assess oxygenation status frequently and intubate with care, ensuring hyperventilation post (check CXR)

-Resuscitation as per surviving sepsis guidelines with fluid, early broad spectrum antibiotics, inotropes with invasive arterial monitoring and central line access as required

ICU/HDU consult