Osmolar gap = measured 360 – calculated 290 = 70 mOsm/L, which is high.
b. Likely causes
Alcoholic ketoacidosis.
Methanol poisoning.
Ethylene glycol poisoning.
c. Bicarbonate therapy
Advantages: severe acidosis may cause cardiac dysrhythmias and reduce cardiac contractility.
Disadvantages: limited or conflicting evidence; may worsen CNS acidosis; can cause hypernatraemia, hypokalaemia, hyperosmolality, and a left shift of the oxygen-dissociation curve.
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