A 50 year old presents with 2 days of a diarrhoeal illness. Her blood results show:

Triple acid base disorder:

HAGMA with high glucose – DKA, check ketones

Delta ratio  0.7, additional NAGMA – diarrhoea

expected CO2 for acidosis is 23, additional respiratory acidosis – partial compensation, check for additional respiratory cause including CNS depression

other relevant – K normal, lactate high