A 73 years old female presents to ED at 0800 in morning with c/o multiple episodes of PR bleed with associated abdominal pain overnight. Last episode was about 2 hours ago. She has T2DM, HTN, and hypothyroidism and is on thyroxine, ramipril and metformin.

OE: looks pale, peripherally cold, HR 120, BP 90 systolic. Temp 33 C. Her VBG was as followed on arrival.

• PH 7.21 ( 7.35 – 7.45)
• PCO2 24 ( 35 – 45 )
• HCO3 12 (22 – 28)
• Cl 100 ( 95 – 110)
• Na 134 ( 135 – 145)
• K 3.4 ( 3.5 _ 4.5)
• lactate 13
• Hb 159
• Creat 140

Questions:

• What is the primary acid base disorder? Calculate compensation.
• What are 3 main abnormalities on this VBG.?
• What is the likley Cause of patients very high lactate in context of presentation and medical background?