Critically ill patient requiring immediate resuscitation and concurrent assessment
4 important features:
HAGMA – DKA most likely, also Renal failure. possible sepsis as cause ppt cause of DKA
Additional respiratory acidosis – not just poor compensation, CO2 is high (expect low if compenation). Hypoventilation (altered GCS), also consider COPD, pneumonia, aspiration
High glucose – DKA
Renal failure
Consider other causes of low GCS
Speciifcs:
pH 7.05, HCO3 low => severe life threatening metabolic acidosis
raised anion gap —– therefore HAGMA
compensation – Winters formula
-expected CO2 is 35, actual 66
Aa gradient 27 — high, implying VQ mismatch or shunt
K high but actual likely to be lower
Elevated Urea and Creatinine
In my opinion HCO3 – are too high as expected (history + for COPD with CO2 elevated and renal compensation? ).