Question 21.2

Created on Wed, 05/13/2015 - 02:49
Last updated on Tue, 08/11/2015 - 18:40
Pass rate: 93%
Highest mark: 10

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A 52-year-old man with a history of alcohol abuse and Type 2 diabetes is admitted with the abdominal pain. His arterial blood gases and biochemical profile are as follows:

Parameter

Result

Normal Range

Barometric pressure

760 mmHg (100 kPa)

FiO2

0.5

pH

7.14*

7.35 – 7.45

PCO2

12 mmHg (1.1 kPa)*

35 – 45 (4.7 – 6.0)

PO2

149 mmHg (20 kPa)

Bicarbonate

4 mmol/L*

22 – 26

Lactate

16 mmol/L*

<2.0

Sodium

142 mmol/L

135 – 145

Potassium

4.7 mmol/L*

3.2 – 4.5

Urea

14 mmol/L*

3.0 – 8.0

Creatinine

0.17 mmol/L*

0.07 – 0.12

Glucose

6.5 mmol/L

3.6 – 7.7

Total Bilirubin

20 micromol/L

4 – 25

LDH

1400 U/L*

50 – 150

AST

60 U/L*

<40

ALT

70 U/L*

<40

Serum Osmolality

314 mOsm/Kg*

275 – 295

  1. Give three likely underlying diagnoses
  2. Give two additional investigations that would assist the diagnosis

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College Answer

a)

  • Ischaemic bowel
  • Metformin induced lactic acidosis
  • Septic shock
  • Thiamine deficiency
  • Pancreatitis

b) 

  • CT abdomen
  • Blood cultures / septic screen
  • Lipase
  • Red cell transketolase 
    Diagnostic laparoscopy / laparotomy

Discussion

This question is identical to Question 15.3 from the second paper of 2009, and Question 26.4 from the second paper of 2013. The answer to the latter contains a comprehensive discussion.