A 40-year-old woman was found unresponsive after a night of ethanol consumption. Her history was significant for alcohol abuse, bipolar disorder, and previous suicide attempts. Respiratory and renal failure occurred soon after hospitalization. Initial laboratory results included the following: blood ethanol, 17 mg/dL [reference interval, 0 or <LOQ (limit of quantification)]; pH, 6.98 (7.35–7.45); PaCO2, 18 mmHg (35–45 mmHg); osmolality, 455 mOsm/kg (281–307 mOsm/kg); and a biochemical profile shown in Table 1. Oxalate crystals were identified in the urine.

Patient biochemical profile at emergency department presentation

Questions

  1. What condition(s) and/or symptom(s) are consistent with the biochemical profile shown?
  2. What is a possible reason for the discrepancy seen in the plasma lactate concentrations?

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