MSRA-0451

MSRA-0451

A 25-year-old homeless man presents to the emergency department with altered consciousness and abdominal pain after being intoxicated a few hours prior. He has a history of alcohol and overdose admissions.

On examination:
A – Airway is clear.
B – Respiratory rate is 34 breaths per minute with deep labored inspiration. Oxygen saturation is 100%.
C – Heart rate is 124 beats per minute, blood pressure is 95/62 mmHg, and capillary refill is 4 seconds. Mucous membranes are dry.
D – Glasgow Coma Scale score is 10.

Lab results show a pH of 7.18 (normal range: 7.35-7.45), pCO2 of 4.3kPa (normal range: 4.5-6.0kPa), bicarbonate of 14 mmol/L (normal range: 22-28 mmol/L), glucose of 22.3mmol/L, and ketones of 4.5mmol/L.

What is the most likely diagnosis?