MRCP2-1504

MRCP2-1504

A 63-year-old male, who recently immigrated from India, presents with a 5-day history of feeling generally unwell. His niece, who is with him at the hospital, denies any recent productive cough, diarrhea, vomiting, or dysuria. The patient has been gradually becoming more malaised over the past 5 days and has not been eating or drinking well. He has no known medical history. On examination, he has dry mucous membranes and cool peripheries, and his JVP is +1 cm above the angle of Louis. Heart sounds, chest, and abdomen are unremarkable. Urine dip and chest radiograph results are pending. The patient’s blood tests reveal:

– WBC: 16 * 109/l
– Neutrophils: 14.8 * 109/l
– Na+: 152 mmol/l
– K+: 3.7 mmol/l
– Urea: 22 mmol/l
– Creatinine: 208 µmol/l
– CRP: 38 mg/l
– Glucose: 38 mmol/l
– Ketones: 2.8 mmol/l

Arterial blood gases:

– pH: 7.31
– PaO2: 20.2 kPa
– PaCO2: 3.0 kPa
– Bicarbonate: 16 mmol/l
– Lactate: 4 mmol/l

What is the likely diagnosis that unifies these symptoms and test results?