A 70 year old female is brought to your ED by her partner, who says that the patient has not been herself in the last few days. She complains of tiredness and fatigue and has been behaving strangely. She has a history of thyroid problems, for which she is on treatment.

Her blood tests show:

pH  7.36

pCO2  36 (35-45 mmHg)

HCO3  26  (22-26 mmol/l)

Na  135  (137-145  mmol/l)

K  4 (3.5-5 mmol/l)

Cl 98  (99-111 mmol/l)

Lactate  2

Glucose  4.3

Ca  3.1  (2.1-2.3 mmol/l)

Describe and interpret the abnormailities

What is the treatment?