39 year old IDDM, presents with a 1 day history of vomiting. The patient has been on an alcohol binge and non-compliant with his insulin.

VBG

pH 7.50                                              Na 141mmol/l

pCO2 39mmHg                                  K 4.1mmol/l

HCO3 30mmol/l                                 Cl 82mmol/l

B/E 7                                                  Cr 136mmom/l

Lactate 3.2                                         BSL 22mmol/l

Ketones 7.8mmol/l

1. Describe and Interpret the VBG
2. How would you manage this patient?