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Without baseline labs and medication review, side effects or interactions can be missed, and titration can become unsafe

tachycardia, tachypnoea, altered level of consciousness presence of risk factors features of underlying cause INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) on blood gas normal osmolar gap normal lactate normal beta-hydroxybutyrate high pyroglutamic acid (urine or blood) MANAGEMENT stop exacerbating factors treat sepsis, including: early and appropriate antibiotics source control supportive care and monitoring intubation, ventilation, renal replacement therapy (RRT) as indicated N-acetylcysteine help replenish glutathione stores References and Links LITFL Metabolic Muddle 004 Staph sepsis and an unusual metabolic acidosis Journal articles Dempsey GA, Lyall HJ, Corke CF, & Scheinkestel CD (2000)

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All purchasers must be a resident of the state where the transfer will occur