Clinical Case 3

A 35-year-old male is brought into resus as a standby call. On arrival the patient appears quite unwell;

• Heart rate is 130 bpm
• Respiratory rate 30 bpm
• Blood pressure 94/58 mmHg
• Temperature 35.6°C
• SaO₂ 99% with 15 L via a non-rebreather mask
• CRT 2.5 sec
• Cool at the peripheries

Examination reveals bibasal chest dullness, no evidence of peripheral oedema and a mildly tender abdomen, which does not appear peritonitic. The patient appears to weigh approximately 100 kg.

You suspect pancreatitis and start resuscitation. Initial bloods show pH 7.28, HCO3 19, pCO₂ 3.4, Lac 3.6 and PO₂ 15.4, WCC of 18.0, urea of 22, creatinine of 168, CRP 160 and amylase of 1243.

Which features suggest severe pancreatitis and that your patient is at risk of a poor outcome?

In this patient, which of the following would be defined as an element of SIRS?