A 56 year old, homeless man was admitted to the emergency department with clinical features suggestive of a bowel obstruction. As he is confused, it is not possible to elicit a clear history.
The first set of blood tests show-
Sodium 137 mmol/L (137-145)
Potassium 4.0 mmol/L (3.1-4.2)
Chloride 98 mmol/L (101-109)
Bicarbonate 15mmol/L (22-32)
Glucose 48mmol/L (3.0-6.0)
Urea 18.0 mmol/L (3.0-8.0)
Creatinine 0.2 mmol/L (0.05-0.12)
What are the possible causes of his metabolic acidosis?
The rest of the viva focussed on the management of hyperglycaemic emergencies
(Endocrinology Metabolism and Nutrition) - Pass rate ; highest mark .