Case of the Month #44 High Anion Gap Metabolic Acidosis

Published 12/10/2023


Theme: Diabetes, Endocrine, Metabolic 

A 66-year-old male is brought into the Emergency Department by ambulance with reduced consciousness and severe agitation. The patient had complained of chest, abdominal and back pain at home. He has a past medical history of type 2 diabetes mellitus, hypertension, ischaemic heart disease (with coronary stents) and an implantable cardiac electronic device (CRT-D). 

Upon examination he has a patent airway, his respiratory rate is 34 breaths per minute, SpO2 91% on room air, heart rate 118 beats per minute and blood pressure 84/52 mmHg. He has cool peripheries and a central capillary refill time of 4 seconds. He is intermittently agitated with a GCS of 11 (E2, V4, M5). 

The Emergency Department team have called urgently for assistance, to facilitate transfer for cross-sectional imaging and ongoing management.