A 14 year old female is brought in to your ED on a priority one by ambulance. She has had a one week history of vomiting and diarrhoea.

On examination:

Obtunded

extensor posturing

BP 40 systolic

PR 120/min

What are your key initial steps?

Her blood results:

Na 119 (137-145 mmol/l)

K > 8 (3.5-5 mmol/l)

Cl 87 (99-111 mmol/l)

HCO3 14 (24+-2 mmol/l)

Urea 25.4 (3-8 mmol/l)

Creat 314 (30-80 umol/l)

BSL 1.9 (4-6 mmol/l)

2. Describe and interpret the blood results

3. What clinical features would you look for to confirm your diagnosis?

4. What are your treatment priorities?

Thank you SETU for this great case