A 59 year old woman is brought to the emergency department with a history of slurring of speech and obtundation. She had a previous episode of severe diarrhea 4 days before admission which resulted in weakness and dizziness. She is a diabetic on treatment with metformin which is well controlled since 8 years. She was also recently initiated on orlistat for dyslipidemia and peptic ulcer medication. On examination, she was afebrile, with heart rate 70 and blood pressure 85/40 mm Hg.
She had no evidence of any injuries, diabetic ulcers, neuropathy or retinopathy. Investigations reveal a low blood glucose level, elevated urea and creatinine, normal serum electrolytes, normal liver function. ESR, CRP and serum amylase levels were normal but serum lactate levels were elevated. An arterial blood gas analysis was done and the interpretation was metabolic acidosis. pH was 6.5 and bicarbonate…
