78 year old lady with mild dementia and type II DM. She was referred from a nursing home for increasing drowsiness over the last 2 days.

Her GP recently changed her diabetic medication and stopped her insulin.

On presentation she was shouting, She looked dehydrated. Pulse rate was 98 and blood pressure was initially 102/58. Temperature was 35.8.

Her Bloods gases (venous) showed the following.

PH = 7.59

PCO2 = 23

PO2 = 27 

HCO3 = 22

Na = 127 mmol/L

Cl = 86 mmol/L

K = 4.8 mmol/L

Glucose = 30 mmol/L

Lactate = 3.8

Ketones = 3.5

Urea = 27.8

Cr = 138.

Questions:

1- interpret her blood gases

2- How will you manage this condition.