NBME Step 2 CK Form 8 Exogenous ingestion of an organic acid (NBME Answers)

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Young man presents with altered mental status found to have a severe anion-gap metabolic acidosis (142 – 102 – 12 = 28 > 12), with exogenous ingestion of an organic acid being the only answer that corresponds with this acid-base disturbance
Excessive loss of bicarbonate = Type 2 renal tubular acidosis (non-anion gap metabolic acidosis)

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cbreland Could also be DKA, but no ketones. Glucose is high, but expected since glucose was given in the hospital. Leads towards ingestion because of lab findings and vignette. +1

link981 @cbreland Can't be DKA. Glucose level is 160. For DKA, glucose has to be greater than 250. -Diabetic ketoacidosis is characterized by a serum glucose level greater than 250 mg per dL, a pH less than 7.3, a serum bicarbonate level less than 18 mEq per L, an elevated serum ketone level, and dehydration. Insulin deficiency is the main precipitating factor. As per the American Association of Family Physicians https://www.aafp.org/afp/2013/0301/p337.html#:~:text=Diabetic%20ketoacidosis%20is%20characterized%20by,is%20the%20main%20precipitating%20factor. +