Review Question - QID 213900

A 33-year-old man with a history of alcoholism and IV drug use presents to the emergency department after being found obtunded in public. The patient was not responsive and was promptly brought to the emergency department. His temperature is 102°F (38.9°C), blood pressure is 107/55 mmHg, pulse is 148/min, respirations are 25/min, and oxygen saturation is 99% on room air. The patient is quickly intubated, and initial resuscitation is started. He is sent to the intensive care unit. Day 1 in the intensive care unit laboratory studies are ordered as seen below.

Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 19,500/mm^3 with normal differential
Platelet count: 297,000/mm^3

Serum:
Na+: 139 mEq/L
Cl-: 100 mEq/L
K+: 3.1 mEq/L
HCO3-: 35 mEq/L
BUN: 33 mg/dL
Glucose: 111 mg/dL
Creatinine: 1.6 mg/dL

Venous blood gas:
pH: 7.50
pCO2: 45 mmHg
PO2: 40 mmHg

Which of the following is the most appropriate treatment for this patient’s acid-base disturbance?