Case of the Month #60 The Acidotic Coma: A Case of Unexplained Rigidity

Published 29/01/2026

How would you begin your diagnostic workup?

  • Venous Blood Gas (VBG) 
  • Ketones 
  • Blood Tests: Full blood count, Renal Function, Liver Function tests, Bone Profile 
  • ECG  

Venous blood gas and blood results of significance: 

pH  <6.8 
PCo2 (kPa)  3.3 
Bicarbonate - HCO3 (mmol/L)  Unrecordable (low) 
Chloride - Cl (mmol/L)  100 
Glucose (mmol/L)  4.8 
Lactate (mmol/L)  19.6 

 

Sodium - Na (mmol/L)  139 
Potassium - K (mmol/L)  5.2 
Blood Urea Nitrogen (mmol/L)  16.3 
Creatinine (mmol/L)  749 
eGFR   5 

 

Bedside ketones: 4.7 mmol/l  

 

ECG: Normal Sinus Rhythm