Activity

After reading on the resources, answer the following questions and bring it to class for
discussion
Question 1
A 70-year-old male is brought to ED. He has gradually become ill over the past 2 weeks. He has
been difficult to arouse for the past one day. He has the following observations at triage.
BP: 85/55 mmHg, HR: 120 b/m (regular), RR: 28 b/m, Temp.: 37.9 oC, SpO2: 93% (room air), GCS:
12/15 (E=3, V=4, M= 5)

The following investigations are available when you are called to attend to the patient.
ABG (room air) Her Results Normal values
PH 7.25 7.35-7.45
PO2 60 mmHg 80-100 mmHg
PCO2 30 mmHg 35-45 mmHg
HCO3 15 mmol/L 22-26 mmol/L
Na 133 mmol/L 135-145 mmol/L
K 4.0 mmol/L 3.5-5 mmol/L
Cl 96 mmol/L 96-106 mmol/L
Lactate 4.0 mmol/L 0.5-2.0 mmol/L
Glucose 55 mmol/L 3.9-6.0 mmol/L

Urea 20mmol/L 2.8-7.2 mmol/L

Creatinine 300 umol/L 70-115 umol/L

Urine ketone 1+

1. Describe and interpret the above results.

2. Formulate your management plan for this patient.
Question 2
A previously well 4-year-old girl is brought to emergency department (ED). Her mother reports
that the girl has been tired over the past 2 weeks and wetting the bed at night. She has been
complaining of abdominal pain over the last 2 days and has vomited twice today. The child is
alert but irritable and does not want you to examine her abdomen. On examination her
abdomen is soft with no specific area of tenderness.
The following are her vital signs:
HR 120 bpm
Capillary Refill 3 seconds
RR 50 bpm
SpO2 98% in room air
Urine dipstick shows +++glucose and +++ketones.
Her blood results are as follows:

Venous Blood Gas Her Results Reference range

pH 7.10 7.35-7.45
PCO2 25 41.0-51.0 mmHg
PO2 27 20.0 – 40.0 mmHg
HCO3 10 21.0-30.0 mmol/L
Urea and Electrolytes
Na 130 135-145 mmol/L
K 4.7 3.5-5.0 mmol/L
Cl 96 95-107 mmol/L
Urea 20.0 1.8-6.4 mmol/L
Cr 120 27-58 µmol/L
Glucose 26 4-8 mmol/L

a. Describe and interpret the above results with differential diagnosis

b. Describe the initial management of this child.

c. Name four (4) complications to watch for while she is being treated in ED.