SAQ 136 – Metabolic – diabetic ketoacidosis with respiratory acidosis

A 45 year old man with type 1 diabetes mellitus is brought in by ambulance with an altered conscious state.

His observations are: BP 90/70 mmHg, HR 120 bpm, temperature 36.8 C, oxygen saturation 97% on 8 L by Hudson mask, GCS 12 (E4, V3, M5).

Initial investigations are shown below.

Test	Result	Units	Reference range
FiO2	0.50
pH	7.05		7.35-7.45
pCO2	66	mmHg	35-45
pO2	247	mmHg	80-95
Bicarbonate	18	mmol/L	22-28
Base excess	-14		-3 to +3
O2 saturation	99	%	>95
Na+	131	mmol/L	134-146
K+	5.0	mmol/L	3.4-5
Cl-	92	mmol/L	98-106
Urea	15	mmol/L	3-8
Creatinine	227	micromol/L	45-90
Glucose	50.9	mmol/L	3.5-5.5

Provide three (3) calculations to help you to interpret these results.

(Marked out of 3.0)

/ 3

Provide a unifying explanation for this clinical picture based on these results.

(Marked out of 3.0)

/ 3

Complete the following table demonstrating three (3) key specific treatment tasks in the first 2 hours of the emergency department stay. For each choice, state how you would achieve each of these tasks.

(Marked out of 6.0)

Key treatment task	How will you achieve the task?
1.
2.
3.

/ 6

Total Score: 0 / 12

Percentage: 0%