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16th September 2024
A 50-year-old man presents to the emergency department with abdominal pain and vomiting
A 50-year-old man presents to the emergency department with abdominal pain and vomiting. He is diagnosed with type 2 diabetes and is currently treated with metformin and dapagliflozin. The emergency doctor assesses him and identifies signs of fluid depletion. He exhibits generalised abdominal tenderness without rebound tenderness or guarding. His vital signs are as follows: BP 90/60 mmHg, HR 105 bpm, temperature 37.3°C, respiratory rate 30 breaths per minute, and oxygen saturation 95%. Blood tests show the following:
| pH | 7.22 (7.35-7.45) |
| PaCO₂ | 4.6 kPa (4.5-6.0) |
| PaO₂ | 10 kPa (10-14) |
| Bicarbonate | 15 mmol/l (22-28) |
| Lactate | 2.5 mmol/l (<1.0) |
| Anion gap | 22 mmol/l (6-16) |
| White blood cells | 144 mmol/l (135-145) |
| CRP | 15 mg/l (<10) |
| Sodium | 144 mmol/l (135-145) |
| Potassium | 4.0 mmol/l (3.5-5.0) |
| Creatinine | 110 µmol/l (55-120) |
| Urea | 9.4 mmol/l (2.0-7.0) |
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