A 19-year-old woman with a history of type 1 diabetes mellitus is brought to the emergency department by her roommate due to severe nausea, vomiting, and confusion for the past 24 hours. She has recently been suffering from a gastrointestinal viral illness and has not been taking her insulin because she was not eating. On physical examination, her mucous membranes are dry, and she is breathing rapidly and deeply.
Laboratory testing shows the following:
| Test | Value | Reference Range |
|---|---|---|
| Sodium () | 140 mEq/L | 136-145 mEq/L |
| Potassium () | 4.8 mEq/L | 3.5-5.0 mEq/L |
| Chloride () | 98 mEq/L | 95-105 mEq/L |
| Bicarbonate () | 12 mEq/L | 22-28 mEq/L |
| Blood urea nitrogen | 28 mg/dL | 7-18 mg/dL |
| Creatinine | 1.2 mg/dL | 0.6-1.2 mg/dL |
| Glucose | 520 mg/dL | 70-110 mg/dL |
Based on these laboratory results, what is the patient's serum anion gap?
Cevap: 30 mEq/L
Cevap
30
The patient presents with diabetic ketoacidosis, which causes a high anion gap metabolic acidosis. The serum anion gap is calculated using the primary measured cations and anions: . Substituting the patient's values yields mEq/L. A normal anion gap is typically between 8 and 12 mEq/L. An anion gap of 30 mEq/L is significantly elevated, confirming the presence of unmeasured anions (in this case, ketone bodies).
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Anahtar Kavram
Calculation and interpretation of the serum anion gap to evaluate metabolic acidosis.