A 30 year old man is brought to your emergency department at 06:30 am on a winter morning by SJA after his partner rang the ambulance.
His partner left him in normal state the night before when she went to work on night shift. On coming back at 0600 she found him semiconcious in bed , confused, complaining of headache intermittently. There was no evidence of overdose , trauma , deliberate self harm at scene. The windows of room were closed and there was heater in lounge room left working overnight because of cold weather.
On arrival to ED patients GCS was fluctuating between 13- 14, RR 14, sats 95 % RA, HR 115, BP 100/70, ECG sinus tachycardia, Temp 37, There was no evidence of head trauma, BSL 15, ketones 0.2, Patients CT head did not show any acute intracranial event. Patients VBG results were as followed.
PH 7.27
HCO3 16
PCO2 44
Na 135
K 4.4
BSL 15
Cl 95
Lactate 10
BAL 0
COHB 38 %
Q1: What are the main metabolic abnormalities on this VBG?
Q2: What is the most likley diagnosis?
Q3: How will you manage this patient?