A 45 year old female is brought in to your ED by ambulance. She was found unconscious at home. She had a history of NIDDM on treatment. There was  some diarrhoea and vomiting the day before.

On arrival to ED the patient had her eyes closed, withdrew from pain and made incomprehensible sounds with trismus.

Vital Signs:

BP 70 systolic

RR  40/min

PR  110/min

Her blood results showed:

pH  6.718  (7.36-7.44)

pCO2  12  (35-45  mmHg)

HCO3  1.5  (22-26  mmol/l)

Na  140  (137-145  mmol/l)

K  5.1  (3.5-5  mmol/l)

Cl  119  (99-111  mmol/l)

Glu  29

Lactate  3.3  (<2 umol/l)

Urea  14.5  (3.5-8  mmol/l)

Creat  143  (<130 umol/l)

What is the GCS?

Describe and interpret the blood results

What is your approach to this patient?