5-day history of vomiting and lethargy.
A 22-year-old female is brought into A&E by ambulance with a 5-day history of vomiting and lethargy. When you begin to talk with the patient you note that she appears disorientated and looks clinically dry. At present, you are unable to gain any further details, but the patient looks very unwell from the end of the bed. You gain IV access, send off a routine panel of bloods and commence some fluids. You ask the nurse to check the patient’s observations and she notes an increased respiratory rate, low blood pressure and tachycardia. You perform an ABG on the advice of your registrar. The results of the ABG are shown below (patient not on oxygen).
PaO2: 13 (11-13 kPa)
pH: 7.3 (7.35 – 7.45)
PaCO2: 4.1 (4.7-6.0 kPa)
HCO3-: 13 (22-26 mEg/L)
BE: – 4 (-2 to +2)
WHAT DOES THE ABG SHOW?WHAT OTHER BEDSIDE INVESTIGATIONS MIGHT BE USEFUL IN NARROWING THE DIFFERENTIAL DIAGNOSIS?WHAT IS THE LIKELY DIAGNOSIS, GIVEN THE PATIENT’S HISTORY AND THE ABOVE RESULTS?HOW HAS THIS ILLNESS LED TO THE ABG DERANGEMENT?