A patient with metabolic acidosis has a markedly increased osmolal gap. Which cause should be considered first?
1Diabetic ketoacidosis with marked accumulation of ketoacids in blood
2Renal failure with retention of organic acids and urea
3Ingestion of an alcohol such as methanol or ethylene glycol✓ 정답
4Lactic acidosis from sepsis and tissue hypoperfusion
해설
A widened osmolal gap means that small molecules not included in the calculated osmolality are present in the blood. Ingestion of alcohols such as methanol or ethylene glycol is the classic cause. Ketoacidosis and renal failure raise the anion gap without producing a large osmolal gap.