A 30 year old patient, previously well presents with vomiting and ringing in her ears.

O/E – She looks unwell. Vitals – RR 30/min,  BP 100/70, PR 105/min

Her ABG is as follows:

pH 7.20

CO2 24 mmHg

HCO3 16       (24 mmol/l)

Na 135         (137-145 mmol/l)

K 3.5          (4-6 mmol/l)

Cl 100        (99-111 mmol/l)

ketones 0.3

Lactate 3       (<1)

Urea 7.5      (3-7 mmol/l)

Creat 100     (<130 umol/l)

1. Interpret her blood gas

2. Give a differential diagnosis and likely cause

3. What is your risk assessment?

4. What are your treatment priorities?

5. What are the indications for haemodialysis?