A 14 year old boy is brought in to your ED by his mum. He has had a bout of nausea and vomiting earlier that day. He is noted by the triage nurse to be slightly drowsy and hyperventilating.

His blood results show:

pH  6.750  (7.36-7.44)

pCO2  31.4  (35-45  mmHg)

HCO3  4.1  (22-26  mmol/l)

Hb  175  g/l

Na  142  (137-145  mmol/l)

K  3.2  (3.5-5  mmol/l)

Cl  115  (99-111  mmol/l)

Glu  26  (4-6  mmol/l)

Lac  3.9   (<2 mmol/l)

Creat  52  (<130 umol/l)

Describe and Interpret the blood tests

What are your Challenges in this patient?

What are the key aspects of management of this patient?