21-year-old man brought for ED for impaired mental state, he was extremely agitated and needed 6 staff members to restrain him for IV access and sedation. His venous blood gases showed the following:

PH = 6.9

pCO2 = 24 mmHg

pO2 = 42 mmHg

HCO3 = 22 mmol/L

Na = 142 mmol/L

K = 5.3 mmol/L

Cl = 101 mmol/L

Hb = 154 g/L

Lactate = 27 mmol/L

Glucose = 8.3 mmol/L

Creatinine = 132 umol/L

Questions:

1. Interpret these results.
2. What are the potential causes of these changes?
3. What is your approach for impaired mental state?