The following patient presents with 1day of vomiting, and has had multiple similar presentations:

ph          6.98
pCo2          70
pO2           45
HCO3          15
Base Xs      -19
Saturation    57
Sample type: Venous

Na           116
K            8.1
Cl            88
IonCa       1.19
Creatinine   204
Hb           149

Glucose       22
Lactate     13.1

Carboxy Hb     0
Met Hb       0.7

What is your diagnosis and management?