Case 1

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86 year old woman presents with decreased consciousness (GCS 10). She has no history of trauma.

On examination:

• Heart rate 90/min
• Blood pressure 110/70
• Clinically dehydrated
• No focal neurological signs
• No neck stiffness

Preliminary investigations reveal:

• Capillary blood sugar: >33 mmol/l
• Haemoglobin 14.6 g/dl
• Arterial blood sample on 10l/min oxygen via non-rebreathing mask:
  • pH 7.246
  • PaCO₂ 3.5 kPa
  • PaO₂ 27.13 kPa
  • Actual bicarbonate 11.1
  • Base excess -14.3
  • Sodium 145 mmol/l
  • Potassium 3.28 mmol/l
• Urine ketones: +++

Describe the blood gas abnormality

©Charles Gomersall, September, 2008 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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