A 30 year old female presents to ED with a 1 week history of vomiting. According to the patient she has no diagnosed medical problems, but has been unwell for the last 6 months intermittently with fatigue, anorexia and weight loss.
On examination BP 90/50 Hr 110 Sats 95% RA Temp 35 RR24. Dry mucous membranes, temporal wasting. GCS 14 – some confusion with regards to place and time.
A VBG is done
pH 7.201 Na 114 mmol/l
pCO2 42mmHg K 7.1 mmol/l
HCO3 16 mmol/l Cl 90 mmol/l
B/E -11.6 Lactate 4.7
Hb 160g/L Cr 138 umol/l
BSL 10.8
1.List 4 acid base and electrolyte abnormalities and show the necessary calculations (6 Marks)
2.List 2 possible differential diagnosis in the case and reasoning for them (4 Marks)
3.Complete the following table comparing the different presentation between primary and secondary adrenal insufficiency (12 Marks)
| Primary Adrenal Insufficiency | Secondary Adrenal Insufficiency | |
| Aldosterone Deficiency | ||
| Volume status | ||
| Serum potassium | ||
| Serum Sodium | ||
| Cushingoid | ||
| Symptoms of other pituitary hormone deficiencies |
- Discuss the immediate management of this patient (4 Marks)