An obtunded 61-year-old Woman weighing 45 kg with Worsening renal function is admitted to the hospital. She has a recent history of several days of nausea, fatigue, pruritus, and a metallic taste in her mouth. Her medical history includes diabetes, heart failure, and COPD. Admission laboratory values include:
SERUM CHEMISTRY
Sodium: 135 mEq/L
Potassium: 5.7 mEq/L
Chloride: 100 mEq/L
HCO3: 15 mEq/L
BUN: 96 mg/dL
Creatinine: 5.5 mg/dL
Glucose: 300 mg/dL
Calcium: 7.4 mg/dL
Serum ketones: Negative
ABGS (Room Air)
pH: 72
PaCO2: 30 mm Hg
PaO2: 75 mm Hg
O2 Sat: 90%
Chest X-ray shows a flattened diaphragm. Current medications include furosemide, fluticasone salmeterol, and glipizide. Which acid-base disorder does this patient exhibit?