A 48 year old diabetic with a history of alcohol abuse is admitted with abdominal pain and the following results:
|
Parameter |
Value |
Normal range |
|
pH |
6.87 |
7.35-7.45 |
|
PaCO2 |
8 mmHg (1.1 kPa) |
35-45 mmHg (4.7-6.0 kPa) |
|
PaO2 |
149 mmHg (20 kPa) |
75-98 mmHg (10.0-13.0 kPa) |
|
Actual bicarbonate |
1.4 mmol/l |
22-26 mmol/l |
|
Lactate |
16 mmol/l |
<2 mmol/l |
|
Sodium |
142 mmol/l |
134-145 mmol/l |
|
Potassium |
4.7 mmol/l |
3.5-5.1 mmol/l |
|
Urea |
14 mmol/l |
3.4-8.9 mmol/l |
|
Creatinine |
170 micromol/L |
(60-110 micromol/L) |
|
AST |
60 |
(<40 U/L) |
|
ALT |
70 |
(<40U/L) |
|
LDH |
1400 |
50-150 U/L |
|
Total bilirubin |
20 |
4-25 micromol/L) |
|
Glucose |
6.5 mmol/l |
|
|
Serum osmolality |
314 |
275-295 mOsm/kg |
a. Give the three most likely diagnoses
b. List two additional investigations that you would perform based on the above information
College Answer
3.3
a) Diagnoses: 3 ischaemic bowel, 2 metformin induced lactic acidosis, thiamine deficiency, pancreatitis.
b) Two of the following investigations: Diagnostic laparoscopy or laparotomy, CT abdomen, red cell transketolase, lipase
Discussion
This question is identical to Question 15.3 from the second paper of 2009.