A 60 year old male presents with 1 week history of vomiting. In the last 24 hours the family noted that he was confused and poor to respond. Background – IHD, HTN, NIDDM on Metformin, Coversyl, aspirin, metoprolol.

On arrival he was confused.

Vitals: BP  80/40   HR 46/min   Temp  34   RR 24/min and GCS 10

ECG sinus bradycardia, QRS 180ms, peaked T waves, PR  240ms.

His VBG:

pH  6.89                                   Na 109mmol/l

pCO2  32mmHg                      Cl 72mmol/l

pO2  61mmHg                         K7.8 mmol/l

O2 sats  87%                           Ur 43mmol/l

HCO3  6mmol/l                        Cr 1401umol/l

BE  -26                                     Lactate 6mmol/l

BSL  83mmol/l

1. Describe and Interpret the VBG
2. What is your immediate management of this patient?