2026 Volume 33 Article ID: 33_R8
There are multiple causes for high anion gap metabolic acidosis. Therefore, it is difficult to identify a single pathophysiology. However, various pathologies should be promptly considered and treated. The patient was a 48-year-old male with type 2 diabetes mellitus and a history of alcohol use disorder. At presentation, the patient had abdominal pain, severe hypoglycemia, and lactic acidosis. Therefore, multidisciplinary care including mechanical ventilation was initiated. Before knowing the history of taking sodium-glucose cotransporter 2 inhibitors, urinalysis and blood gas tests by the simplified Stewart approach revealed ketoacidosis. The patient was started on insulin early to correct the acidosis. The patient was subsequently diagnosed with hypoglycemic diabetic ketoacidosis based on blood ketone levels. It is important to assess the accumulation of other ions using the simplified Stewart approach to manage the complex pathophysiology of high anion gap metabolic acidosis.
