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Mesenteric ischaemia with lactic acidosis — SCE Acute Medicine MCQ

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EasyAcute Renal and Metabolic EmergenciesMesenteric ischaemia with lactic acidosisSCE Acute Medicine

A 45-year-old woman presents with vomiting, weakness, confusion or collapse. Relevant history includes diabetes, kidney disease, endocrine disease or a treatment trigger. On assessment, volume status and bedside physiology are abnormal. Investigations show pain out of proportion, lactate 7.2 and SMA occlusion on CTA. What is the most appropriate next step in management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Arrange urgent vascular and surgical intervention with resuscitation

The key discriminator is that pain out of proportion, lactate 7.2 and SMA occlusion on CTA, which makes Arrange urgent vascular and surgical intervention with resuscitation the single best answer. Give analgesia and antiemetic therapy is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Call critical care for escalation and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: ESVS mesenteric ischaemia guideline