Author: Abubaker Elhag, Mohamed Elsayed, Mohamed Nasralla / Editor: Sarah Edwards / Codes: EnC2, SLO1, SLO6, SuC8, SuP1, SuP7 / Published: 18/09/2025
A 77-year-old woman presents to the Emergency Department (ED) with generalised abdominal pain, having attended the previous day with similar symptoms. She describes the pain as dull and constant, accompanied by nausea, vomiting, and anorexia.
Her past medical history includes hypertension and chronic kidney disease. A contrast enhanced CT abdomen performed during her previous attendance showed mild diverticulitis, and she was discharged with a 7-day course of oral co-amoxiclav (625 mg TID).
On review today, she appears unwell but remains alert and oriented. She is hemodynamically stable and apyrexial. Examination of the abdomen reveals a soft, nondistended abdomen with normal bowel sounds and no tenderness, guarding, or organomegaly. Cardiorespiratory examination is unremarkable.
Initial Investigations
Venous Blood Gas (VBG):
- pH: 7.223 ↓
- PCO₂: 4.21 kPa ↓
- HCO₃⁻: 13.0 mmol/L ↓
- Base Excess: -13.4 mmol/L ↓
- Glucose: 7.9 mmol/L ↑
- Lactate: 2.3 mmol/L ↑
- Chloride: 115 mmol/L ↑
Blood Tests:
- WBC: 16.34 × 10⁹/L ↑
- CRP: 165 mg/L ↑
7 responses
One of the interesting modules many thanks!
Excellent,
This is easily missed case in a very busy department based on last CT results, needs careful thinking about the VBG and careful approach
Thanks for sharing.
A diagnosis that can be easily missed, especially in the practical setting of the NHS. Excellent case, I will definitely remember this during my practice.
Thank you!
Really informative, thank you.
Great Revision
excellent question and information
Good take home, glucose can be fairly normal in a DKA