SAQ 1197 – Combative older patient with abnormal blood gas and diabetes

A 78-year-old woman presents from home combative. Her neighbour found her lying on the floor of her ground-floor unit. She has diabetes treated with metformin and is normally well.

Her blood gas and laboratory results are shown below.

Test	Result	Reference range
pH	7.30	7.35-7.45
pCO2	31 mmHg	35-45
pO2	90 mmHg	95-100
HCO3	20 mmol/L	22-28
Na	140 mmol/L	135-145
K	3.9 mmol/L	3.5-4.5
Cl	105 mmol/L	95-110
Urea	21.8 mmol/L	2.9-7.1
Creatinine	220 umol/L	45-90
Glucose	40 mmol/L	3.0-7.8
Lactate	4.8 mmol/L	<2

What is the most likely diagnosis? Explain your answer using the results.

(Marked out of 2.0)

/ 2

What complications of this diagnosis is this patient showing?

(Marked out of 3.0)

/ 3

Name one cause of her high lactate.

(Marked out of 1.0)

/ 1

How would you interpret her ABG taken on room air?

(Marked out of 4.0)

/ 4

Total Score: 0 / 10

Percentage: 0%