A 57 year old lady presents to your ED with abdominal pain, shortness of breath and vomiting for 1 day. She has reduced appetite and last ate 2 days ago.

She has high cholesterol and type II DM and is taking a statin and Jardiamet.She looks unwell.

Vital signs: HR 130/min, BP 100/60

Abdomen – tender epigastrium

Blood results show:

pH 7.01

pCO2  31

HCO3  7

BE  -24

Na  146

K  4.4

Cl  113

Creat  69

Glucose  10.5

Lactate  1.5

Ketones 6

Describe and interpret her blood gas

What are the possible precipitants?