You are a Health Administrative Assistant working in a healthcare

presents with a 3-day history of fever; cough productive of yellow, blood-tinged sputum; confusion; and dizziness when standing. Past medical history includes type 1 diabetes mellitus (DM). A physical examination in the emergency department indicated postural hypotension, tachycardia, and Kussmaul respirations. The breath was noted to smell of “acetone.” Examination of the chest/lungs by auscultation indicated consolidation in the right lower lobe. Sodium 130meq/l, potassium 5.0 meq/l, chloride 96 meq/l, CO2 14 meq/l, BUN 20mg/dl, Creatinine 1.3 mg/dl, glucose 450 mg/dl ph 7.39, PCO2 24, PaO2 89, HCO3- 14, Anion gap 20, Urine ketones positive +4, Urine Glucose Positive +4, urine serum ketones strongly positive 1:8, Chest x-ray pneumonic infiltrate, right lower lobe. What acid-base imbalance does this patient exhibit?

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