55 Year old female presents with a 1 week history of diarrhoea and vomiting. She has recently been discharged from hospital after treatment of spontaneous bacterial peritonitis. She has a background of cirrhosis of the liver and diabetes on metformin+dapagliflozin combination. The patient has a needle phobia and was hyperventilating for some time prior to the insertion of the drip.

Below is the patients VBG:

pH 7.50                                   Na 140mmol/l

pCO2 21mmHg                      K  3.4mmol/l

pO2 19mmHg                         Cl 105mmol/l

HCO3 16mmol/l                      Cr 70umol/l

Lactate 7.5                              Glucose 12.4mmol/l

B/E -5

1. Describe and interpret the VBG
2. What class of drug is metformin + dapagliflozin combination and what are the precipitants for the DKA that this class of drug can cause.