Author: Sohail Bin Abdullah, Asfan Hashmi, Vibhor Tiwari / Editor: Nick Tilbury / Codes: CP2, RP5, SLO1 / Published: 12/05/2022

A 52-year-old male presents with a 2-day history of being unwell. He reports lethargy and nausea, is passing dark-coloured urine and has had one episode of vomiting. He is known hypertensive and suffers from sleep apnea, otherwise fit and well.

On arrival, he is found to be febrile and tachypnic with sats of 83% on 15lo2 oxygen. The patient is not complaining of breathlessness.

On examination, he is found to be jaundiced, looks pale, has mild RUQ tenderness and no guarding or rigidity. The rest of the  examination is unremarkable.

An arterial blood gas is taken:

Ph – 7.52
PCO2 – 4.27
PO2 – 22.8
Na – 142
K – 3.1
Cl – 103
Lac – 1.1
Hb – 75
SpO2 – 100
COHb – 2.3
MetHb – 7.9
BE – 5.4
HCO3 – 27.9