A 62 year old man presents to your ED by ambulance. He has had vomiting and diarrhoea for the last week and complains of abdominal pain. He is unable to keep anything down, has severe weakness with inability to stand.

PMH:

Femoral bypass one week ago

Type II DM on insulin

Peripheral vascular disease

Diverticulitis

CCF – shortness fo breath on exertion

His blood results:

pH  7.258  (7.36-7.44)

pCO2  34.1  (35-45 mmHg)

HCO3  15.2  (24+/-2)

BE  -10.9

Glu   2.6  mmol/l  (3.4-6.1)

ketones  4  mmol/l (<0.6)

Lactate   13.6  mmol/l (<2)

Na  142  (137-145 mmol/l)

K  4.4  (3.5-5 mmol/l)

Cl  94  (99-111 mmol/l)

Urea  26.3  (2.8-7.5 mmol/l)

Creat  692  (<130umol/l)

Hb  129 ( 130-170 g/l)

Plt  417  (140-400)

WCC  19  (4-11)

Neutrophil  12  (4-7)

Questions:

1. Describe the abnormalities

2. Give a reasonable explanation

3. What are the possible causes