A 30 year old man is brought to your ED by ambulance. He was found lying on his garage floor unconscious by his girlfriend after an earlier argument. He is a NIDDM on Metformin and has some psychological problems on Quetiapine.

The patient is a car enthusiast and works as a mechanic.

On Examination:

BP 110/70  HR 130 Sats 96RA  RR 24  T  36.4

GCS 13  (E3,M6,V4)

VBG:

pH         7.05                                        Na         144  mmol/l

HCO3      10    mmol/l                          K             4.0 mmol/l

PCO2      25    mmHG                          Cl            105  mmol/l

Lactate    18   mmol/l                          Creat       120  umol/l

Glucose    6     mmol/l                         Urea        8mmol/l

Ca 0.99mmol/l                                    Measured Osmolality 330 Osmol/kg

BAL 0.08

1. Describe and Interpret the VBG
2. What is the use of the osmolar gap and what non toxicological conditions are associated with a raised osmolar gap?