Journal article
Hunting down a double gap metabolic acidosis
Annals of clinical biochemistry, Vol.47(Pt 3), pp.267-270
05/2010
DOI: 10.1258/acb.2010.009213
PMID: 20406777
Abstract
Double gap metabolic acidosis occurs in the setting of unmeasured active osmoles in the serum (osmolal gap) and anion gap (AG) metabolic acidosis. We describe a 67-year-old woman with acute respiratory failure on mechanical ventilator from pneumonia and anuric acute on chronic renal failure (urea nitrogen 21.4 mmol/L, creatinine 530.4 micromol/L) requiring haemodialysis (HD). On hospital day 5, she was found to have progressive metabolic acidosis (serum pH 7.16, PCO(2) 4.38 kPa, HCO(3)(-) 12.1 mmol/L and AG 21 mmol/L). There was no evidence of hypoxaemia, hypoperfusion or haemodynamic instability. Normal serum ketone and L-lactate but high serum osmolal gap (89.4 mmol/kg) was detected. A search for toxic alcohols revealed a high serum propylene glycol (PG 32.9 mmol/L), a stabilizing solvent for intravenous formulations of lorazepam, which was being used as sedation for mechanical ventilation. Unexpectedly, serum L- and D-lactate as metabolites of PG were not elevated. Although extended HD for eight hours completely removed serum PG and the osmolal gap, the predialysis high AG metabolic acidosis persisted, potentially related to hypercatabolism and anuric renal failure. PG should be in the differential diagnosis of the disorders with high osmolar gap and may not always be associated with L- or D-lactic acidosis.
Details
- Title: Subtitle
- Hunting down a double gap metabolic acidosis
- Creators
- Ming-Tso Yan - National Defense Medical CenterTom Chau - Providence St. Vincent Medical CenterChih-Jen Cheng - National Defense Medical CenterShih-Hua Lin - National Defense Medical Center
- Resource Type
- Journal article
- Publication Details
- Annals of clinical biochemistry, Vol.47(Pt 3), pp.267-270
- DOI
- 10.1258/acb.2010.009213
- PMID
- 20406777
- ISSN
- 0004-5632
- eISSN
- 1758-1001
- Language
- English
- Date published
- 05/2010
- Academic Unit
- Nephrology; Internal Medicine
- Record Identifier
- 9984383904802771
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