Other emergencies
Case 11: A Patient with Bloody Diarrhoea and Pain
CASE
A 64‐year‐old man with ulcerative colitis (UC) is admitted to hospital with bloody diarrhoea and abdominal pain. He has been getting progressively more unwell over the previous 2 years with frequent episodes of severe colitis, which are becoming increasingly difficult to treat. He has been on ciclosporin for the last 12 months and has been taking 4 mg of prednisolone a day for the last week. Stool frequency is more than 10 per day, he has a high fever of 39°C. He is flushed and looks unwell. Capillary refill is prolonged at 5 seconds and jugular venous pressure is not visible. A tachycardia of 120 beats/min in sinus rhythm is recorded with a BP of 90/60 mmHg. Respiratory rate is 28 breaths/min with oxygen saturations of 94% on air, the lungs are clear. His abdomen is tender and he has guarding but no rebound. He appears unwell and a catheter is introduced; he passes 20 mL of urine for each of the following 2 hours. Routine blood tests show that he is: anaemic with a haemoglobin of 8 g/dL, Urea is raised at 18 mmol/L, creatinine is normal and CRP >200 mg/L.
He is given high‐flow oxygen and an arterial blood gas performed:
pH 7.29 PaO2 48 kPa PaCO2 3.2 kPa HCO3 15 mmol/L Base excess −8 SaO2 100% Lactate 4.1 mmol/L
QUESTION 1
Your score this session: 0 of 0
Which of the following are true?