RT Journal Article SR Electronic T1 Survival from profound metabolic acidosis due to hypovolaemic shock. A world record? JF BMJ Case Reports FD BMJ Publishing Group Ltd SP bcr2012008315 DO 10.1136/bcr-2012-008315 VO 2013 A1 Nicola Di Rollo A1 David Caesar A1 David A Ferenbach A1 Mark J G Dunn YR 2013 UL http://casereports.bmj.com/content/2013/bcr-2012-008315.abstract AB This case describes the unexpected survival of an adult man who presented to the emergency department with hypovolaemic shock secondary to a splenic haemorrhage. Before surgery he had a pH 6.527, base excess (BE) −34.2 mmol/l and lactate 15.6 mmol/l. He underwent a splenectomy after which his condition stabilised. He was managed in the intensive care unit postoperatively where he required organ support including renal replacement therapy but was subsequently discharged home with no neurological or renal deficit. Although there are case reports of patients surviving such profound metabolic acidosis these have mainly been cases of near drowning or toxic alcohol ingestion. To the best of our knowledge this is the first reported case of survival after a pH of 6.5 secondary to hypovolaemic shock.