Diagnostic Challenge in a Patient with Severe Anion Gap Metabolic Acidosis

Table 1

Admission laboratory values.

Laboratory	Value	Reference
Hemoglobin	11.5 g/dL	12.0–15.5 g/dL
Hematocrit	35.2%	34.9–44.5%
Leukocytes	26.6 × 10^3 cells/uL	3.4–10.5 × 10^3 cells/uL
Leukocyte differential	85.6% neutrophils, 7.5% lymphocytes, 6.8% monocytes, 0% eosinophils, and 0.1% basophils	41–77% neutrophils, 20–45% lymphocytes, 0–12% monocytes, 0–6% eosinophils, and 0–2% basophils
Platelets	298 × 10^3 cells/uL	150–450 × 10^3 cells/uL
INR	1.3	0.8–1.2
Prothrombin time	17.0 seconds	9.5–13.8 seconds
Sodium	138 mM/L	136–148 mM/L
Potassium	7.5 mM/L	3.5–5.0 mM/L
Creatinine	2.1 mg/dL	0.6–1.1 mg/dL
Blood urea nitrogen	52.6 mg/dL	6.0–21.0 mg/dL
Chloride	111 mmol/L	100–108 mmol/L
Bicarbonate	5.8 mmol/L	21–32 mmol/L
Calcium	8.8 mg/dL	8.4–10.4 mg/dL
Total protein	7.4 g/dL	6.3–8.2 g/dL
Magnesium	2.3 mg/dL	1.6–2.3 mg/dL
Alkaline phosphatase	83 IU/L	55–142 IU/L
AST	41 IU/L	15–46 IU/L
ALT	41 IU/L	10–43 IU/L
Total bilirubin	<0.40 mg/dL	0.10–1.00 mg/dL
Blood and urine cultures	No growth	No growth