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NDT Plus Advance Access originally published online on August 4, 2008
NDT Plus 2008 1(6):433-436; doi:10.1093/ndtplus/sfn108
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Sweet and sour—a patient with life-threatening metabolic acidosis and acute renal failure

Robert Schorn1, Robert Kalicki2, Cornelius Remschmidt1, Gunnar Schley1, Niklaus Höfliger1 and Fabienne Aregger2

1 Department of Medicine and Nephrology, Kantonsspital Zug
2 Department of Nephrology and Hypertension, Inselspital, University of Berne, Switzerland

Correspondence: Correspondence and offprint requests to: Niklaus Höfliger, Artherstrasse 27, 6300 Zug, Switzerland. Tel: +41-417097837; Fax: +41-4107098813; E-mail: niklaus.hoefliger@zgks.ch

Key Words: anion gap • kussmaul respiration • metabolic acidosis • osmolar gap

Received for publication February 7, 2008. Accepted for publication July 9, 2008.

The first 150 words of the full text of this article appear below.


   Introduction
 
Several circumstances can cause a metabolic acidosis. Some cases pose diagnostic problems. Mindful clinical evaluation and logical laboratory work-up are crucial to find the correct diagnosis. We report the case of a patient with a severe metabolic acidosis. Further investigations led to an unexspected diagnosis in a timely fashion contributing to an uneventful recovery.


   Case
 
A 49-year-old man consulted the emergency department with a brief history of moderate headache, anomia and ataxia. There was no fever, and no evidence of infection, trauma or alcohol intake. His medications included mirtazepin and escitalopram for a history of depression. On first examination, the patient was confused and incoherent without focal neurologic signs. Electrocardiogram, head CT-scan, chest X-ray and lumbar puncture showed no abnormalities. Initial laboratory findings (haematology, serum electrolytes, creatinine, urea, glucose, C-reactive protein, ethanol) were within normal limits. A moderate leucocytosis of 13.3 g/l was noted. Could this be basilar-type migraine or something . . . [Full Text of this Article]


   Discussion
 

   Teaching points
 

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