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)
Acute renal failure with severe hyperkalaemia
Elevated sepsis markers – WCC, N, CRP
Shock – elevated lactate (high associated mortality)
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.
– 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