Author: Adrian Boyle / Editor: Frank Sutherland / Reviewer: Rebecca Ford, Amanda King / Codes: A3, CC10, PP2 / Published: 14/09/2022
A 45-year-old man attends the department with a 48 hour history of nausea and vomiting. He also has a diffuse upper abdominal pain. He is known to drink heavily and has been on a “binge” for the last week. He then developed a chest infection. On examination, he is a thin, unkempt man with dry mucous membranes. He denies any regular medication. He is not intoxicated, jaundiced or tremulous. His chest is clear and his abdomen is soft with no guarding. His pulse is 90, GCS 15. BP 125/60. He is afebrile. An arterial blood gas is obtained.
- pH 7.1
- PC02 2.92 kPa
- PO2 14.5 kPa
- Na 135.2 mmol/l
- Ca 1.3 mmol/l
- K 2.6 mmol/l
- H+ 50 nmol/l
- BE -13 mmol/l
- HC03 12 mmol/l
- Sa02 94.2%
- Lactate 6.0 mmol/l
- Glucose 5.2 mmol/l
His formal blood results showed:
- Urea 15.8 mmol/l
- Creatine 160 mmol/l
- Amylase 45 mmol/l
- Hb 12.8 g/dl
- MCV 104
- WCC 10.3
Urine dipstick is strongly positive for ketones only.
