A 50 year old man is brought to your ED by ambulance. He complains of feeling unwell, fever, cough and difficulty breathing. He denies any chest pain or history of previous heart problems.

On examination he looks unwell, tachypnoeic and has very cold peripheries.

Vitals

BP 150/90

HR 140/min, sinus

T 38

RR 26/min

O2 sats 96 RA

His initial VBG showed:

pH 7.33     pCO2  47  HCO3  24   Na 129  K 5.0   Cl 100  Creat 87   Glu 10   Lactate 3.4

After 2 litres of fluid:

pH 7.28   pCO2 38   HCO3 18   Na  128   K 5.0   Cl 106   Creat 70  Glu 8.6  Lactate  3.1

After a further litre:

pH  7.20  pCO2  45  HCO3  17  Na  129  K 5.0  Cl  111  Creat  62  Glu  10  Lactate 2.6

Trop  4.53

INR  1.5

WCC 19.2

Describe and interpret his venous gasses and explain the change.

Interpret the rest of the results in this context.