Acid-base disturbances Quiz: Ace Your Exams

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A 90-year-old woman is brought to the emergency department for evaluation of new onset confusion. Two days ago, her family noticed she decreased her oral intake. This morning, her family found her slumped over in a chair and unresponsive. She has a history of type 2 diabetes, dementia, and hypertension, for which she takes insulin, donepezil, and hydrochlorothiazide. One week ago, she was started on isoniazid, rifampin, ethambutol, and pyrazinamide for active pulmonary mycobacterium tuberculosis infection. Her temperature is 36.4°C (97.5° F), pulse is 80/min, respirations are 22/min, blood pressure is 110/60 mmHg, and oxygen saturation is 98% breathing room air. She appears stuporous. Physical examination shows conjugate eye deviation to the right and brisk reflexes with bilateral ankle clonus. Lung exam is normal. Laboratory studies show the following:  


Which of the following is the most likely explanation for these laboratory findings?  

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