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.