Viva 2

A 45 year old previously healthy man was transferred to your ICU 5 days ago after a motor vehicle accident with chest and abdominal  injuries. He has been difficult to ventilate on 100% oxygen and 10cm H2O of PEEP. He is deeply sedated and on noradrenaline and adrenaline infusions at 10mcg/min each. He has become oliguric.

His blood biochemistry and blood gases are as follows:


Sodium

138 mmol/L

(135-145)

Potassium

7.1  mmol/L

(3.5 – 5.0 )

Chloride

104  mmol/L

(95-105)

Urea

27    mmol/L

(4-6)

Creatinine

0.26 mmol/L

(0.04-0.12)

Glucose

7.5  mmol/L

(4-6)

pH

7.01

PCO2

45  mm Hg

PO2

70  mm Hg

Bicarbonate

11  mmol/L

(24-27)

Summarise the findings of the first blood tests

Focus of discussion: Evaluation and management of metabolic and raised anion gap acidosis

Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.