A 70 year old man with severe urosepsis requiring early resuscitation and antibiotics has blood tests which show:

NAGMA (AG = 11)

additional Respiratory alkalosis (full compensation has CO2 at 34)

Sepsis with end organ involvement:

-high lactate

-renal failure

mild hyponatraemia

Consider bowel to bladder fistula (recto vesicle fistula secondary to malignancy, inflammatory disease) as cause of NAGMA and urosepsis AND CNS cause for the hyperventilation.