A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which showSevere HAGMA
uncompensated, or additional respiratory acidosis
Delta ratio of 2.0 – likely HAGMA without metabolic alkalosis
Elevated glucose
elevated ketones
osmolality 316
mild hyponatraemia
severe total body K depletion
renal failure
likely severe DKA BUT if lactate is 3.8 and ketones are 6.9 what accounts for the rest of the anion gap?
toxic alcohol
metformin
What if I told you his measured osmolality was 357?