Back to acid-base – what the heck is going on?

I have had several requests to provide some acid-base questions (seemingly a favorite topic).   We discussed this patient at morning report recently.   49-year-old man with DM type I diagnosed 25 years ago  progressed to ESRD s/p renal transplant x 2, second 3 years ago, and gastroparesis with worsening post-prandial N&V * 3 months with abnormal labs. Medications: Insulin Mycophenolic acid PPI Prednisone Tacrolimus   134 106 47 241 4.7 9 3.4   albumin 4.4 Your questions: 1. What is the likely acid-base disorder – i.e., predict that ABG? 2. Explain the likely etiology.    
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Acid-Base & Lytes Source Type: blogs