Author: Hannah Phillips / Editor: Steve Corry-Bass / Codes: EnC5, SLO3 / Published: 14/09/2023

An elderly lady wakes up feeling odd and confused so calls an ambulance for assistance.

The paramedics find she has a GCS 15 but a blood glucose of 2.3 and temperature of 33.1˚C. She is treated with a biscuit, orange juice and oral glucagon as initial cannulation is unsuccessful.

On arrival in the emergency department (ED), she is speaking coherently, with no chest or abdominal findings but is hypotensive (BP 81/49) and tachycardic (HR 135) with an irregular pulse.

Her past medical history includes hypertension and osteoarthritis and her regular medicines are lisinopril and co-codamol.

The first arterial blood gas shows:

  • pH 6.97 (7.35 – 7.35)
  • pCO2 3.4 (4.6 – 6.4 kPa)
  • pO2 14.5 (11.0 – 14.4 kPa)
  • BE -24.6 (-2 to 3 mmol/L)
  • Anion gap 41 (10 – 20 mmol/L)
  • Bicarbonate 5.7 (19 – 28 mmol/L)
  • Lactate 17.4 (<1 mmol/L)