Case 3

A previously well 55 year old woman is admitted with a complaint of severe vomiting for 5 days. Physical examination reveals postural hypotension, tachycardia, and diminished skin turgor. The laboratory finding include the following:

Electroyes: Na 140 , K 3.4, Cl 77 HCO3- 9, Cr 2.1
ABG: pH 7.23 , PCO2 22mmHg