A 60 year old male presents with 1 week history of vomiting. In the last 24 hours the family noted that he was confused and poor to respond. Background – IHD, HTN, NIDDM on Metformin, Coversyl, aspirin, metoprolol.

On arrival he was confused.

Vitals: BP  80/40   HR 46/min   Temp  34   RR 24/min and GCS 10

His VBG:

pH  6.89                   pCO2  32                      pO2  61      O2 sats  87%

HCO3  6                    BE  -26

Glucose  83

Lactate  6

Ca  1.07

Hb  102

Na  109                  Cl  72                   K  7.8

Urea  43               Creat  1401

Describe and interpret the blood tests

How would you manage this patient?

Describe the ECG changes you would expect

Thanks to Fiona Beattie

Answer will be posted 31/8/17