A 65 year old woman has been taken to the ED with large volume haematemesis. She has a history of alcoholism and type 1 diabetes mellitus. An arterial blood gas has been provided below.

Arterial blood gasValueUnitsReference range
FiO20.90
pH7.17(7.35 – 7.45)
pCO232mmHg(35 – 45)
pO275mmHg(60 – 100)
HCO311mmol/L(22 – 32)
Na117mmol/L(135 – 145)
K3.5mmol/L(3.5 – 5.2)
Cl64mmol/L(95 – 110)
Glucose34.3mmol/L(3.0 – 7.8)
Lactate8.1mmol/L(0.5 – 2.2)
Hb78g/L(115 – 160)

1. State (3) acid-base disturbances. Provide calculations and likely causes for each. (9 marks) 9 marks

2. Briefly explain the likely factors influencing the sodium of 117. (3 marks) 3 marks

Vital signs: GCS 13 HR 125 BP 75/45 RR 40 SpO2 92% 15L NRB T 36

3. State (6) components of your management of this patient. (6 marks) 6 marks