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Case Study •Ms. Keller is a 29-year-old computational engineer presenting to ED at 0900hrs. She woke up feeling unwell this morning. Had diarrhea x7 episodes, vomiting x2, constantly nauseated, lower abdominal crampy pain. Fevers for last 5 days. Had a laparoscopic procedure for endometriosis 7 days ago. •Had 2 cans of Bourbon yesterday. Denies any dysuria, urinary frequency, cough. Appears unwell. Pleasantly confused, thinks she is 42 years old. •Poor historian ? Due to confusion. •Past Medical History: Type I DM, Previous ICU admissions for DKA, Endometriosis Fully vaccinated against COVID Assessment: Airway. – Patent Breathing. – Spontaneous, RR-19/mt, SPO2-95% RA, air-entry equal Circulation- Appears flushed, tepid peripheries, BP-86/62 mmHg, HR- 46/mt, sinus bradycardia, dry mucous membranes Disability – GCS-14 E4V4M6, not oriented to time, place or person, PEARL- 2mm. Exposure – Temperature 39.8 deg Celsius. Abdomen soft and tender lower abdomen+++ on palpation, bowel sounds present. X2 IVC in situ. Laparoscopic site erythematous. Fluids – Unable to tolerate oral fluids, NBM for now Glucose – BGL-Hi, Ketones- 3 Investigations: •ABG: pH- 7.36, HCO3- 39, BE-(-4.8), Lactate- 3.2 •Urine analysis: Negative for nitrites and leukocytes, urine appears very concentrated, Beta HCG -negative •Bloods- WCC- 17.4, CRP- 15•Additional information: Currently Actrapid +5% dectrose 80mL/hr running with KCL @70mL/hr •Diagnosis: Moderate DKA with a septic foci ? Post-op infection •A MET call was activated at 1230hrs. Question: Discuss TWO diagnostic results and relate it to the underlying pathophysiology.

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