Hypobicarbonatemia with an elevated anion gap on a metabolic panel is frequently the initial marker of a life-threatening condition such as diabetic ketoacidosis in a patient with epigastric pain. The two commonly used means of measuring bicarbonate levels are direct measurement from a metabolic panel and calculated measurement from arterial blood gas. In this case report, we would like to highlight a potentially serious deficiency in one of these two means and how it may lead to a dangerous misdiagnosis and subsequent mismanagement. We also shine a light on potential measures to counteract or prevent this undesirable outcome.
Keywords: acute pancreatitis; anion-gap metabolic acidosis; diabetic ketoacidosis (dka); epigastric pain; hepatosplenomegaly; hypertriglyceridemia (htg); hypobicarbonatemia; serum bicarbonate.
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