Case of the Month #44 High Anion Gap Metabolic Acidosis

Published 12/10/2023

Additional clinical information

A collateral history evidences that he is ordinarily active, continues to work and had been well until 2 days ago, when he started to feel non-specifically unwell. 

His regular medications are: aspirin, bisoprolol, clopidogrel, dapagliflozin, metformin, rosuvastatin and sacubitril with valsartan. 

An arterial blood gas is taken, showing: pH <6.80, PaO2 11.1 kPa, PaCO2 2.3 kPa, Na+ 134 mmol/L, K+ 4.1 mmol/L, Cl- 90 mmol/L, glucose 8.3 mmol/L, lactate 15.4 mmol/L, BE ‘incalculable’, HCO3-  ‘incalculable’ 

Capillary ketones read >6 mmol/L.  

An ECG shows sinus tachycardia. 

A bedside point of care echocardiogram shows severe generalised biventricular systolic dysfunction.