42 year old male patient with history of fever sice -5 days not had taken treatment any came with breathlessness and after examination DIABETIC rbs 377 patinet was intubated and his vitals are PR 140 BP 120/90 chest bilateral crepts present investigations hb 14.4 platelets 42000 s.creatinine 1.5 tsb 9.4 urine ketones negative please help



This is a case of Sepsis in a diabetic patient leading to Mixed Acidosis due to both Metabolic component (decreased HCO3 n increased lactate) and Respiratory component (increased pCO2).... Xray looks like a picture of ARDS (due to underlying sepsis) He needs ventilatory support asap... Broad spectrum antibiotics including Vancomycin or Teicoplanin

Ac LRTI + DM+ ARDS +MOF. X-Ray chest- extensive patchy consolidations with some cavitary lesions., left dome of diaphragm is elevated. ABG- Respiratory acidosis + Metabolic acidosis, hypokalemia, Lactic acidosis. S. Cr 1.5, total bilirubin 9.4, platelet 42000. Mechanical ventilation with low TV, low end inspiratory airway pressure( platue pressure) , high PEEP. Maintain fluid, electrolytes, PH balance and blood sugar. Platelet transfusion. Prone position, judicial administration of sedatives, broad spectrum Antibiotics. proper Antibiotics/ antifungal drugs or antiviral drugs after the report of Blood CS, Urine CS, Bronchial aspiration CS reports come in hand. Lactic acid more than 4 mmol/L has a very bad prognosis. Better prognosis with ECMO than traditional MV. CBC, ABG, RFT, LFT, S.Electrolytes, BT, CT, PTT, Platelet count, X-ray chest, 2D-Echocardiography, USG Abdomen, Urine for RE, ME, CS, Blood for CS, Bronchial aspirations fluid for CS.

Acute respiratory acidosis HAGMA,Lactic acidosis ARDS Thrombocytopenia,AKI, check out Urinary ketones and controll sugar Check out psmp, dengue and H1N1 Correct K and hco3 simultaneously as on 7.0 ph corrected K is 0.3 only. Keep on PC mode with positive pressure ventilation. Ca is ionized?? check out serum .ca with albumin

dengue negative urine ketonse negative potassium correction going on one doubt is that both respiratory and metabolic acidosis is there is it correct to treat sodium bicarbonate sir doubt

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ARDS with mixed acidosis. Needs to consider alveolar hemorrage as well. Judicious sodabicarb correction,hyperventilation. Glycemic control. Sos ionotropic support. Antibiotics, Electrolytes correction.

ARDS secondary to infection with abg showing mixed respiratory and metabolic acidosis; send all infection panel including h1n1, gene xpert mtb, bacterial panel, pcp stain

ARĎS with mixed acidosis. Needs to consider alveolar hemorrhage as well. Judicious sodabicarb correction hyperventilation .

ARDS Looks secondary to infection with abg - mixed acidosis

Well managed.continue resp support. Aggressive treatment of resp infection .prevent Mof. Already ARDS like changes have set in. Rule out H1N1 ,Dengue ,Leptospirosis in case come in contact. Repeat the investigations to confirm the patient on road to recovery.

Acidosis Ruled out causes of decrese plaetelet HIV? Viral Pneumonia secondary to sepsis?

B/l soft shadows all over lung fields.possibly Covid with Ards.Acidosid

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