2 year old male BIB mother with a 24 hour history of fever, diarrhoea and vomiting. 

The child has been vomiting half hourly for last 12 hours and had large frequent non bloody stools. The parents are unsure when the child last past urine due to the large amount of diarrhoea. No significant past medical history, no sick contacts (but attends day care) and no travel history. IUTD

Examination – P180 BP 67 systolic Sats 99% RA RR 28 Temp 38.5 BSL 2.1

Floppy, lethargic child CPR>4 sec, dry mucous membranes, mottled skin, no rash

VBG                                                  Na 135

pH7.024                                                K 3.9

PCO2 40.5                                            Cl 109

PO2 25                                                  Ur 18.4

HCO3 10.5                                           Cr 202

B/E -19.7

Lactate 10.1

Describe and Interpret the blood results

What are likely causes for the above clinical picture

What are the immediate resuscitation issues that need to be addressed for this child