A 2 year old boy is brought in to ED by his grandparents, having found him unresponsive at their home. He has no significant past medical history.

On examination he is drowsy with a GCS of 7 (E2V1M4) and has the following observations:

BP 80/50 mmHg

HR 140/min

RR 18/min

O2 sats 100% on 2 litres nasal cannula

T 36.5

His VBG is as follows:

pH 7.1 (7.35-7.45)

O2 50 mmHg

CO2 37 mmHg (40-50)

HCO3 11 mmol/l (24-32)

Lactate 8.8 (0.5-2)

Na 143 mmol/l (135-145)

K 3.8 mmol/l (3.5-4.8)

Cl 110 mmol/l (95-110)

Glu 1.8 mmol/l (3-6)

Questions:

1. List the acid base abnormalities

2. Give an appropriate differential diagnosis

3. What are the normal vital sign parameters for this age group?

4. What are your initial resuscitation priorities?