The case is that of 58 year-male with type 2 diabetes mellitusfor 7 years, hypertension, hypercholesterolemia, who was admittedto the hospital with left lower limb cellulitis over the past 8 days.On work-up he was found to have high anion-gap metabolic acidosis(AGMA) with anion gap of 25, his lactate levels were normal (Dand L-lactate). He denies overdosing with any medications and histoxicology screen for methanol, ethanol, aspirin, and ethylene glycolwere negative. He has no psychiatric history of note. He denies usingover the counter medications like acetaminophen. No bowel surgerycould be elicited. He felt dehydrated and nauseous but otherwisefine.His medications includes; carvedalol 25mg twice daily,hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeksago to control his blood sugar level and A1C.Physical examination of the patient revealed, slightly dehydratedbut well-nourished man, his vital signs; heart rate of 78 BPM andregular, BP 143/85 mmHg, temperature 98.7 F, and his oxygensaturation while breathing room air was 92%. Examination of theheart, abdomen, and chest were unremarkable. He had left lower legcellulitis but no edema or tenderness.His work-up including chemistry-7 which showed sodium of142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L,bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78mg/L respectively. His blood glucose level was 178 mg/L with A1Cof 8.2. His serum osmolality was 312 mosm/L, and his arterial bloodpH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of32mmHg. His calculated anion gap was 25 given his normal albuminlevel. His investigation also showed positive ketones in the serumand urine. His urine PH was 5.5 and the urine contain >800 mg ofglucose
The case is that of 58 year-male with type 2 diabetes mellitus for 7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high aniongap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine. His medications includes; carvedalol 25mg twice daily, hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin 81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeks ago to control his blood sugar level and A1C. Physical examination of the patient revealed, slightly dehydrated but well-nourished man, his vital signs; heart rate of 78 BPM and regular, BP 143/85 mmHg, temperature 98.7 F, and his oxygen saturation while breathing room air was 92%. Examination of the heart, abdomen, and chest were unremarkable. He had left lower leg cellulitis but no edema or tenderness. His work-up including chemistry-7 which showed sodium of 142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L, bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78 mg/L respectively. His blood glucose level was 178 mg/L with A1C of 8.2. His serum osmolality was 312 mosm/L, and his arterial blood pH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of 32mmHg. His calculated anion gap was 25 given his normal albumin level. His investigation also showed positive ketones in the serum and urine. His urine PH was 5.5 and the urine contain >800 mg of glucose.
The author discusses a case of herpes simplex encephalitis in a young man presented with headache and continuous seizures. The CNS infection with grand-mal seizures resulting in tissue breakdown and complications of acute kidney injury and lactic acidosis. Once the seizures are brought under control the lactic acidosis and the AKI resolved, but the patient tormented from the CNS squeals of HSE in the form of neuropsychiatric complications with long-term effect that necessitate 24-hour care to cope with his daily livings.
7 years, hypertension, hypercholesterolemia, who was admitted to the hospital with left lower limb cellulitis over the past 8 days. On work-up he was found to have high anion-gap metabolic acidosis (AGMA) with anion gap of 25, his lactate levels were normal (D and L-lactate). He denies overdosing with any medications and his toxicology screen for methanol, ethanol, aspirin, and ethylene glycol were negative. He has no psychiatric history of note. He denies using over the counter medications like acetaminophen. No bowel surgery could be elicited. He felt dehydrated and nauseous but otherwise fine. His medications includes; carvedalol 25mg twice daily, hydrochlothiazide 25 mg daily, Lipitor 20 mg daily, insulin, aspirin 81 mg daily, and was started on canagliflozoin 300 mg daily 4 weeks ago to control his blood sugar level and A1C. Physical examination of the patient revealed, slightly dehydrated but well-nourished man, his vital signs; heart rate of 78 BPM and regular, BP 143/85 mmHg, temperature 98.7 F, and his oxygen saturation while breathing room air was 92%. Examination of the heart, abdomen, and chest were unremarkable. He had left lower leg cellulitis but no edema or tenderness. His work-up including chemistry-7 which showed sodium of 142 mmol/L, potassium of 4.3 mmol/L, chloride of 102 mmol/L, bicarbonate of 13 mmol/L, BUN and creatinine of 18 mg/L and 0.78 mg/L respectively. His blood glucose level was 178 mg/L with A1C of 8.2. His serum osmolality was 312 mosm/L, and his arterial blood pH was 7.2 with a carbon dioxide in blood gas analysis (Pco2) of 32mmHg. His calculated anion gap was 25 given his normal albumin level. His investigation also showed positive ketones in the serum and urine. His urine PH was 5.5 and the urine contain >800 mg of glucose.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.