55 years old male is brought to emergency department by SJA with complaint of generally feeling unwell for last 24 hours or so. His past medical history includes T2DM, HTN, CRF and currently on peritoneal dialysis. He has been compliant with his dialysis and has not noticed any cloudy bags. He denies any infective symptoms, but seems to complain about spasms in his arms, hands and twitching of face  for last 12 hours. He also feels lightheaded and has following observations.

HR 95, BP 92 systolic, afebrile, RR 20, sats 95 RA. His VBG results are as followed.

PH        7.32

PCO2    42

HCO3    22

Na         136

K           5.3

Lactate   2.3

Creatinine   380 ( baseline 350).

Cl            95

Questions:

1. Describe and interpret above VBG results?
2. What other blood test you would be requesting based on above clinical picture?
3. What ECG abnormalities would you expect if blood test requested in question 2 comes back abnormal and consistent with clinical picture?
4. How will you treat this patient ?