A 36 year old man presents to your ED with epigastric pain, right upper quadrant pain and vomiting. He admits to drinking excessive amounts of alcohol but denies any alcohol for the past 4 days.

Vital Signs:

BP 100 systolic

PR  120/min

RR 24/min

Sats 99% room air

His blood gas is as follows:

pH  7.006

pCO2  25.9  mmHg   (35-45)

pO2 80 mmHg

HCO3  5.5  mmol/l   (24+/-2)

BE   -23   mmol/l   (-2 — +2)

Na 136  mmol/l (137-145)

K  5   mmol/l   (3.3-5)

Cl  109  mmol/l  (99-111)

Glucose   5.4 mmol/l  (3.4-6)

Lactate  1.5   mmol/l   (<2)

1. Describe the abnormalities

2. Give a differential diagnosis for these abnormalities

Thank you to Jaswinder for this case