42 year old woman presented with 2 days of vomiting and behavioural changes. She had pulse rate of 120/min. Blood pressure was 94/56. Pulse rate and blood pressure didn’t respond to fluid therapy.

Her blood gases showed the following:

PH = 7.16

pCO2 = 31 mmHg

HCO3 = 13.3 mmol/L

Na = 135 mmol/L

K = 3.8 mmol/L

Cl = 95 mmol/L

Lactate = 0.9 mmol/L

Glucose = 2.1 mmol/L

Cr = 78 umol/L

Questions:

1. Interpret these results
2. What are your differentials
3. How will you manage this patient