Case Report
Severe Metabolic Acidosis: A Case of Triple Hit with Ketogenic Diet, Vinegar, and Metformin in an Obese Patient
Table 1
Laboratory investigations at time of admission and discharge.
| | Laboratory variables (units) | Labs on admission | Labs on discharge | Normal values |
| | PCO2 (mmHg) | 31 | 43 | 41–51 | | HCO3 (mmol/L) | 10.5 | 23.5 | 23–29 | | pH | 7.15 | 7.35 | 7.31–7.41 | | WBC (×109/L) | 10.6 | 2.0 | 4.5–10 | | Hemoglobin (g/dl) | 11.4 | 7.9 | 12–16 | | Platelets (×109/L) | 231 | 93 | 150–440 | | Sodium (meq/L) | 131 | 142 | 135–145 | | Potassium (meq/L) | 3.8 | 4.1 | 3.5–5.0 | | Chloride (meq/L) | 94 | 104 | 98–108 | | Blood sugar (mg/dl) | 108 | 103 | 74–100 | | HbA1C (%) | 5.1 | NA | <5.7 | | Osmolality (mOsm/kg) | 298 | 300 | 281–297 | | Anion gap | 27 | 6 | 5–14 | | Serum albumin | 4.7 | 3.0 | 3.1–4.5 | | Serum acetone | 3+ | NA | Negative | | BUN (mg/dL) | 19 | 6.1 | 7–18 | | Creatinine (mg/dL) | 2.37 | 0.9 | 0.6–1.10 | | Serum ethanol (mg/dL) | 18 | NA | Negative | | Lactic acid (mmol/L) | 4.19 | 1.89 | 0.7–2.10 | | Salicylate level (mg/dL) | <2 | NA | 2–20 | | Methanol level | Negative | NA | Negative | | D-Lactate | <0.2 | NA | <0.50 | | Isopropyl ethanol | Negative | NA | Negative | | Antipancreatic islet cell Ab | Negative | NA | Negative |
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NA, values not available.
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