SAQ 575 – Endocrinology – severe hyperglycaemia with metabolic acidosis

A 48-year-old woman presents with two days of shortness of breath. She has diabetes and depression, and her local doctor has been treating a presumed upper respiratory tract infection without improvement.

She is awake and oriented on assessment. Her arterial blood gas is shown below.

Observation	Result
Blood pressure	150/90 mmHg
Heart rate	120/min
SpO2	99% room air
Temperature	36.8 C

Parameter	Result	Reference range
pH	7.10	7.32-7.42
PCO2	39 mmHg	41-51
PO2	94 mmHg
HCO3	12 mmol/L	20-40
Base excess	-16 mmol/L	-3 to +3
Sodium	128 mmol/L	135-145
Potassium	5.2 mmol/L	3-5
Chloride	97 mmol/L	95-107
Glucose	47 mmol/L	3.0-10.0
Creatinine	125 mmol/L	50-120

State the acid-base abnormality.

(Marked out of 1.0)

/ 1

Complete the requested calculations.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Calculation</th> <th>Result</th> </tr> </thead> <tbody> <tr> <td>A-a gradient</td> <td></td> </tr> <tr> <td>Delta gap</td> <td></td> </tr> <tr> <td>Expected K if normal is 4</td> <td></td> </tr> <tr> <td>Corrected sodium</td> <td></td> </tr> </tbody> </table> <p>

/ 4

List three (3) essential treatments, including dosage.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Treatment</th> <th>Dose</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> </tbody> </table> <p>

/ 6

Four hours after treatment starts she becomes drowsy and responds only to painful stimuli. List three (3) urgent investigations and give one (1) justification for each.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Investigation</th> <th>Justification</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> </tbody> </table> <p>

/ 6

Total Score: 0 / 17

Percentage: 0%