27 year old male is brought into ED by his parents who are concerned about the patients mental health, the patient showing increasing anxiety and low mood over the last few weeks.

After a long wait the patient absconds from ED and is brought back a few hours later by ambulance who has been called by a concerned member of the public who has found the patient with an altered mental state on the street.

O/E HR140 RR22 Sats 96%RA Temp 39 degrees C BP 140/90

GCS 11-12  E4 V2 M5-6. Appears anxious and agitated

CNS – increased tone and reflexes, no clonus, generalised tremor. Dilated pupils.

VBG:

pH7.1                                               Na 137mmol/l

pCO2 27mmHg                                K 3.5mmol/l

HCO3 10 mmol/l                             Cl 106mmol/l

B/E -16                                               Cr 77umol/l

Lactate 14                                         BSL 8mmol/l

1. Describe and interpret the VBG
2. Discuss the management of this patient