You are FY2 in ED Anthony Josua, is a 45 yr old who has been unwell for the last 5 days and has been brought in by the Ambulance.
A rapid arterial blood sampling test
PH -7.125
PCo2 -5.7
Arterial lactate 5.4mmol/L
Electrolyte- NAD
Glu- 10.5
Talk to patients and address the concerns
APPROACH
Grips
Paraphrase …result sharing method
P…body weakness x5days
Generalised aches, increase intake of water,…ODIPARA
Sx…r/o other GIT sx
Tummy ache
Nausea/ vomiting
Fever
DD
Dm…polyuria, wgt loss
UTI…dysuria
FMAM + DESA
Explore previous hx of DM,and rx
Examine…
Investigation
Explain results …normal first before abnormal
Diagnosis…MALA…high ketones , acidosis , normal Glucose
MANAGEMENT
Admit
Stop offending medication…here metformin
IV fluids with 0.9% Normal saline to rehydrate.
Give IV 8.4% bicarbonate infusion
Painkiller
INO2…if indicated
Treat underlying condition…eg infection
Antibiotics based on hospital protocol
Inform seniors
Address concern
Leaflet
Safetynet