A 30 year old man presents to your Ed with a 24 hour history of increasing weakness.

An ABG and electrolytes are performed:

pH   7.25   (7.36-7.44)

pCO2  29  (35-45 mmHg)

pO2   101  mmHg

FiO2   Room air

HCO3  13   (22-26mmol/l)

BE   -13  (-2-2)

Na   137  (135-145  mmol/l)

K   1.8  (3.2-4.3  mmol/l)

Cl   116   (99-111  mmol/l)

Urea  7.8  (3-8  mmol/l)

Creat  86  (<130umol/l)

Glucose   4.0  (3-5.5  mmol/l)

CK   1975   (<150  U/L)

Trop     0.04  (<0.05)

Questions:

1. Describe the abnormalities

2. Give a reasonble differential diagnosis

3. What is the likely cause of his weakness