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An 18-year-old man who had been found unresponsive and face down in his bed after spending the day working in his garage is brought to the hospital emergency department.He had not responded to naloxone administration given by the paramedics.His history reveals that he was despondent over the recent death of his father,with whom he enjoyed restoring antique automobiles.Laboratory results indicate negative serum acetone,elevated serum urea and creatinine,normal PO2,decreased bicarbonate,increased PCO2,and increased osmol gap and anion gap.Urinalysis indicated many oxalate crystals.A second anion gap is calculated and the value has increased from the initial value.Based on these laboratory results and the likely compound that has affected this individual,what type of acid-base imbalance is present?
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