Acid base disorders practice

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Year 4common
A 50-year-old man presents to the emergency department with confusion, rapid breathing, and general weakness. He has a history of chronic kidney disease. On examination, he is tachypnoeic. Laboratory investigations reveal: Arterial pH 7.28 (7.35-7.45), HCO3- 17 mEq/L (21-27 mEq/L), PCO2 32 mmHg (35-45 mmHg). Which of the following is the most likely cause of his acid-base disorder?