A 35 year old female presents to your ED feeling unwell with gerealised weakness and altered mental state. She is severely emaciated

Her blood gas shows:

pH  7.497

pCO2 58.7  mmHg   (35-45)

HCO3   45.5  mmol/l  (24+-2)

BE   20.3

Hb    103  g/l

Na   130   mmol/l (137-145)

K   1.8  mmol/l  (3.5-5)

Cl   80  mmol/l   (99-111)

Glu   5.5 mmol/l  (4-6)

Lactate  1.4  (<2)

Questions:

1. Describe the abnormalities

2. Give a reasonable differential diagnosis

3. What are the treatment priorities?