Viva 4

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

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.