Nephrology Cases #9: Severe Metabolic Acidosis During A Suicide Attempt

From the New England Journal of Medicine:

A 73-year-old man presented with a self-inflicted stab wound to the abdomen. A plasma ethanol level of 27 mg per deciliter was found on preliminary toxicologic screening; the results of chemical analyses were normal. No internal injuries were found on exploratory laparotomy. Eight hours postoperatively, the patient became confused and was intubated because of respiratory distress. Arterial blood gas measurements showed a pH of 6.91, partial pressure of carbon dioxide of 12 mm Hg, and base excess of –30 mmol per liter. Blood chemical analyses showed a bicarbonate level of less than 5 mmol per liter, a creatinine level of 1.4 mg per deciliter (123.8 µmol per liter), an anion gap of 26, and serum osmolarity of 346 mOsm per liter with an osmolar gap of 38 mOsm per liter...

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