A 10 year old obese female with abdominal pain, who is unwell requiring resuscitation. She is hypotensive, tachycardic and hypothermic suggesting severe sepsis.

Question 1

Uncompensated (normal CO2 – even though venous) high anion gap (17) metabolic acidosis

Delta gap – 0.8 => likely pure HAGMA especially with elevated lactate

Renal failure – ?pre renal due to dehydration, supported by high lactate

Elevated glucose – consider DKA (this patients ketones were negative and glucose not high enough for typical DKA)

Question 2

Abnormal liver function suggesting biliary obstruction

Very high Lipase

These blood in the setting of abdominal and sepsis suggest gallstone pancreatitis, Cholecystitis. Unlikely to be due to DKA.

Question 3

Resuscitation

Gen surg consult

+/- USS