Board Review Course & Update

BRCU 2025: Test Your Knowledge

A 45-year-old man is admitted to the ICU for pneumonia. Intravenous vancomycin and cefepime are initiated. He is also receiving IV diazepam. His other medications include insulin, carvedilol, atorvastatin, and levothyroxine. Three days after admission, his laboratory studies reveal:

pH 7.14

pCO₂ 30 mm Hg

Na 140 mEq/L 

Cl 105 mEq/L 

HCO₃ 10 mEq/L

BUN 40 mg/dL

Cr 1.5 mg/dL

Glucose 100 mg/dL 

Osmolarity 340 mOsm/L

Which of the following is the most likely explanation for these laboratory values:

1. Septic shock
   
2. Vancomycin
   
3. Cefepime
   
4. Diazepam
   
5. Levothyroxine
   

Show Answer

Reference:

• Fenves, Andrew Z., Michael Emmett. "Approach to Patients with High Anion Gap Metabolic Acidosis: Core Curriculum 2021." American Journal of Kidney Disease 78, no. 4 (2021): 590–600. doi: 10.1053/j.ajkd.2021.02.341

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