PSEUDOHYPOBICARBONATEMIA IN A PATIENT PRESENTING WITH SUSPECTED DIABETIC KETOACIDOSIS

ABSTRACT Objective: In the diagnosis of acid-base disturbances, an accurate assessment of bicarbonate is essential. It can be determined by measurement of a urea and electrolyte panel or calculated on a blood gas analysis. Discrepancies in these two values can be due to endogenous interferents. We report a case of pseudohypobicarbonatemia suspected due to hypertriglyceridemia, despite lipidemia being within the reported acceptable range for the analyzer. Methods: We detail the hospital course of a 33-year-old man who presented with presumed diabetic ketoacidosis based on new-onset hyperglycemia, positive ketones, and measured bicarbonate in the range 9 to 16 mmol/L. The latter caused the calculation of anion gap metabolic acidosis. We review bicarbonate metabolism and technical aspects of its measurement. Further, we review additional reports and research pertinent to our patient's diagnostic dilemma. Results: Based on our patient's initial presentation, he was placed on an insulin drip for approximately ...