An 87-year-old nursing home resident arrives at the ER with a 2-day history of fever, vomiting, and progressive lethargy. The patient's past medical history is significant for advanced dementia and stroke. . The temperature is 38.3 ° C. (101 degrees F), the blood pressure is 88/62 mm Hg, and the pulse rate is 120 bpm. On examination, he appears to be lethargic but arousable. Over the right midlung, coarse rhonchi can be heard. Laboratory results are as follows: Which of the following is the most likely cause of this patient's increased anion gap?

Question

An 87-year-old nursing home resident arrives at the ER with a 2-day history of fever, vomiting, and progressive lethargy. The patient's past medical history is significant for advanced dementia and stroke.  . The temperature is 38.3 ° C. (101 degrees F), the blood pressure is 88/62 mm Hg, and the pulse rate is 120 bpm. On examination, he appears to be lethargic but arousable. Over the right midlung, coarse rhonchi can be heard. Laboratory results are as follows:  Which of the following is the most likely cause of this patient's increased anion gap?

Quizplus · Accepted Answer

Eductional Objective: Lactic acidosis in septic shock is caused by tissue hypoxia, which impairs oxidative phosphorylation and causes pyruvate to lactate shunting after glycolysis. Hepatic hypoperfusion also contributes to lactic acid buildup because the liver is the primary site of lactate clearance.

An 87-Year-Old Nursing Home Resident Arrives at the ER with a 2-Day