每日一题_2022.1.30

A 40-year-old, disheveled(凌乱的) man with a history of alcohol abuse（酗酒） is brought to the emergency department with altered mental status. He was picked up by prehospital personnel on the street after a pedestrian found him passed out on the ground. On arrival, he is arousable（可唤醒的） to voice and denies（否认） any toxic ingestion, but becomes agitated（激动的） quickly during questioning. Vitals signs are: heart rate 130 beats/min, blood pressure 120/60 mm Hg, respiratory rate 34 breaths/min, temperature 38°C (100.4°F), oxygen saturation 90% on room air. Physical examination is notable for temporal wasting, a protuberant（膨隆） abdomen with a fluid wave, caput medusae（海蛇头）, scleral icterus, and crackles in the right lung base. Laboratory analysis shows white blood cell count of 15,000/μL, mild anemia（轻度贫血） and thrombocytopenia（血小板减少）, sodium 131 mEq/L, creatinine 1.5 mg/dL, glucose 70 mg/dL, anion gap 22 mEq/L, osmolar gap 8 mOsm/kg, lactate 2.5 mmol/L, urinalysis 3+ ketones, and undetectable ethanol level. Arterial blood gas analysis reveals a pH of 7.28, partial arterial carbon dioxide pressure 30 mm Hg, partial arterial oxygen pressure 80 mm Hg, and bicarbonate 15 mEq/L. Chest radiograph shows right lower lobe infiltrate. Head CT is unremarkable.

Which of the following is the most likely cause of the patient’s metabolic disturbance?

A. Ethylene glycol（乙二醇） poisoning

B. Isopropyl alcohol（异丙醇） intoxication

C. Diabetic ketoacidosis（糖尿病酮症酸中毒）

D. Alcoholic ketoacidosis（酒精性酮症酸中毒） and lactic acidosis