Abstracts from the 6th Annual Conference of Emirates Society of Internal Medicine (ESIM) 2025

BackgroundSeptic shock with extreme acidemia is rare and life-threatening, demanding rapid, coordinated critical-care management.When pH falls to levels typically incompatible with life, therapeutic decisions (airway, vasopressors, renal replacement, and antimicrobials) become uniquely challenging.We report a 71-year-old man with profound acidemia and septic shock to highlight clinical course and management priorities. Materials and MethodsSingle-patient case report.Data were abstracted from the medical record (history, examination, laboratory/ABG trends, imaging, microbiology) and interventions (resuscitation, vasopressors, ventilation, renal replacement therapy, antimicrobials). ResultsA 71-year-old man with hypertension, diabetes, and obstructive sleep apnea presented tachypneic, tachycardic, and hypotensive.Initial arterial blood gas (ABG) showed mixed respiratory/metabolic acidosis (pH 6.8), deteriorating to pH 6.5 despite fluids; he remained conscious (GCS 15/15).Norepinephrine was initiated.Labs indicated renal and hepatic dysfunction with elevated inflammatory markers.He was intubated, admitted to ICU, started on continuous renal replacement therapy (CRRT), later transitioned to intermittent hemodialysis.Prolonged ventilation required tracheostomy on day 15; extubation attempts were unsuccessful.Cultures grew multidrug-resistant Acinetobacter and Klebsiella; antibiotics were escalated per susceptibilities.Despite aggressive, multidisciplinary care, instability persisted due to refractory infection and hemodynamic compromise. ConclusionsExtreme acidemia in septic shock requires early ABCs, serial ABGs with neurological documentation, immediate broad-spectrum antibiotics and norepinephrine (within 1 hour), and early mechanical ventilation to reduce work of breathing.Consider bicarbonate when HCO <10 mmol/L with hemodynamic compromise, and initiate CRRT early for refractory acidosis or acute kidney injury.Source control and MDRtargeted therapy are pivotal.Further work should refine prognostic thresholds and algorithms for pH <6.8.