The Real-World Boards: Question #46
Acid, acid everywhere
These are the Real-World Boards. As in the real world, there is often no “right” answer, and you are only competing against yourself. Upgrade to the Lifelong Learner level for full access to all the questions and unlimited CME credits with an included Learner+ account.
A 46-year-old man is brought to the emergency department after being found confused on the street. He is homeless and known to be a heavy alcohol consumer. He is cachectic, tachypneic, and mildly hypotensive. Laboratory studies show:
You note the anion gap of 30. pH is 7.25. A crystalloid bolus, bicarbonate, and IV insulin are being delivered. As you prepare to calculate the patient’s osmolality, you see the medical student’s scribbled notation:
She turns to you and asks,
