A previously well 16-year-old girl attends ED with her concerned parents because she has developed worsening postural faintness over three weeks and cannot stand. She has no previous medical history but has had 10 kg weight loss and fatigue over six months. There are no infectious features.
Her observations and venous blood gas/biochemistry are shown below.
| Measure |
Result |
Reference range |
| Lying BP / HR |
102/71, HR 102 |
|
| Standing BP / HR |
78/58, HR 123 |
|
| pH |
7.29 |
7.32-7.43 |
| pO2 |
43 |
25-40 |
| pCO2 |
28 |
41-50 |
| HCO3 |
11 |
23-28 |
| Base excess |
-14 |
-2 to 2 |
| Lactate |
1.3 |
<2.0 |
| BSL |
2.4 |
3.0-7.8 |
| Hb |
173 |
120-160 |
| Na |
129 |
135-145 |
| Cl |
116 |
95-110 |
| K |
5.3 |
3.4-5.0 |
| Creatinine |
140 |
50-120 |
Describe the acid-base state.
(Marked out of 3.0)
/ 3
List the four (4) other main biochemical abnormalities and their significance.
(Marked out of 4.0)
/ 4
What is the most likely diagnosis and why?
(Marked out of 3.0)
/ 3
Total Score: 0 / 10
Percentage: 0%
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