Question

A 27-year-old woman with a history of type 1 diabetes mellitus presents to the emergency department with abdominal pain, nausea, and severe, intractable vomiting for the past 48 hours. She stopped taking her insulin yesterday due to an inability to tolerate oral intake. On physical examination, her pulse is 118/min, blood pressure is 98/60 mm Hg, and respiratory rate is 18/min. Her mucous membranes are dry.

Arterial blood gas on room air reveals:
pH: $7.38$
$pCO_2$: $42 \text{ mm Hg}$

Serum laboratory results are as follows:
Sodium: $140 \text{ mEq/L}$
Potassium: $3.1 \text{ mEq/L}$
Chloride: $88 \text{ mEq/L}$
Bicarbonate: $24 \text{ mEq/L}$
Glucose: $610 \text{ mg/dL}$
Blood urea nitrogen: $42 \text{ mg/dL}$
Creatinine: $1.8 \text{ mg/dL}$

To evaluate for the presence of a mixed acid-base disorder, the physician calculates the delta-adjusted bicarbonate (also known as the expected bicarbonate derived from the delta gap). Assuming a baseline normal anion gap of $12 \text{ mEq/L}$, what is this patient's delta-adjusted bicarbonate (in mEq/L)?