35 year old with probable eating disorder with altered mental state and weakness
1. Abnormalities:
Primary metabolic alkalosis
compensation: Expected CO2 = 54, actual = 59 –additional respiratory acidosis
Severe hypokalaemia, hypochloraemia
mild hyponatraemia
Low anion gap (not acidosis, just low anion gap)
Normal lactate
2. Differential Diagnosis:
Metabolic alkalosis:
Severe dehydration – vomiting, reduced intake
Possible endocrine abnormality – Conn’s, Cushing’s
Diuretic abuse
Respiratory acidosis:
compensation plus central cause – drugs, bleed, infection etc
Severe electrolyte depletion – losses from GIT, kidney
Low anion gap without associated acidosis – low albumin is major determinant, also low PO4
3. Treatment Priorities:
Cardiac monitoring
Replace K
ivi fluids, monitor urine output
ICU admission