39 year old man presents with life threatening illness
- High anion gap metabolic acidosis – with high BSL, lactate, normal creatinine – likely DKA
Winter’s: expected CO2 12.5, actual 17.7 – uncompensated, in the context of altered mental state likely additional respiratory acidosis
Delta ratio = 0.76, close to 0.8 so likely pure HAGMA
Corrected Na = 136, normal
Corrected K = 2.5 mmol of shift, actual K 3.4 with total body K depletion => care when starting Insulin, will require K supplementation
Lactate – shock, sepsis etc
2. Airway/ Breathing issues:
Likely to require intubation:
Reusc bay with adequate experienced staff
Experienced person to intubate, not a teaching case
Drugs
- haemodynamic status – cardiostable drug dosage
- paralytic – sux vs roc
- low pH – dependant on high resp rate – risk of arrest on paralysis
- First time pass on intubation
- consider HCO3 as adjunct prior to paralysis
- hyperventialton on ventilation
- etc, etc