17 January 2022
: Case report 
Severe Anion Gap Metabolic Acidosis Resulting from Combined Chronic Acetaminophen Toxicity and Starvation Ketosis: A Case Report and Literature Review
Challenging differential diagnosis, Adverse events of drug therapy, Rare coexistence of disease or pathology
Thomas Kalinoski1ABCDEF*DOI: 10.12659/AJCR.934410
Am J Case Rep 2022; 23:e934410
Table 1. Laboratory profile of the patient at each presentation over 6 months.
| Visit 1 | Visit 2 | Visit 3 | Visit 4 (last hospital admission) | |
|---|---|---|---|---|
| Serum bicarbonate (meq/L, normal 22–29) | 12 | 10 | 7 | 8 |
| Serum anion gap (meq/L, normal 6–12) | 25 | 25 | 28 | 28 |
| Serum sodium (meq/L, normal 135–145) | 153 | 149 | 146 | 144 |
| Serum potassium (meq/L, normal 3.5–5.1) | 4.5 | 3.5 | 4.0 | 5.0 |
| Serum chloride (meq/L, normal 98–107) | 116 | 114 | 111 | 108 |
| Serum calcium (mg/dL, normal 8.5–10.1) | 9.2 | 9.1 | 9.1 | 10.2 |
| Serum BUN (mg/dL, normal 6–24) | 23 | 16 | 16 | 8 |
| Serum creatinine (mg/dL, normal 0.74–1.35) | 1.28 | 1.05 | 1.12 | 0.99 |
| Serum glucose (mg/dL, normal 70–99) | 116 | 109 | 103 | 111 |
| Serum lactate (mmol/L, normal 0.5–2.2) | 1.8 | 1.7 | 1.6 | 2.0 |
| Urine ketones (mg/dL, normal negative) | 40 | 40 | 15 | 5 |
| Venous Blood Gas pH (normal 7.31–7.41) | – | – | – | 7.17 |
| Venous blood gas pCO2 (mmHg, normal 41–51) | – | – | – | 22 |
| Serum AST/SGOT (U/L, normal 5–35) | 44 | 49 | 49 | 49 |
| Serum ALT/SGPT (U/L, normal 12–78) | 51 | 43 | 46 | 59 |
| Serum alkaline phosphatase (U/L, normal 46–116) | 191 | 160 | 148 | 172 |
| Serum total bilirubin (mg/dL, normal 0.2–1.0) | 0.4 | 0.3 | 0.3 | 0.6 |
| Serum albumin (g/dL, normal 3.3–5.3) | 3.1 | 3.1 | 3.0 | 2.5 |