A 49 year old man with NIDDM on Metformin is brought to the ED by his father. He was not seen for 2 days, father went to check on him and found him lying on the floor, confused and incoherent.

On arrival he was confused, not cooperative and looked unwell.

Vital Signs:

BP 90/60

PR 130/min

T 32

RR 30/min

His blood tests:pH  7.04

pCO2  24  mmHg

HCO3  6  mmol/l

Na  129  mmol/l

K  3.7  mmol/l

Cl  74  mmol/l

Urea  18  mmol/l

Creat  255  umol/l

Glucose  41  mmol/l

Lactate  3.8  mmol/l

Ketones 6.9

Describe and interpret his blood results