LAUSR

Both CXR and CT scan of the head were normal. A normal CT scan of the abdomen ruled out the possible lactate elevation caused by mesenteric ischemia. Further laboratory workup showed an elevated creatinine, anion Gap of 20, osmolal gap of 4 mOsm/kg, plasma lactate level was normal at 1.6 mmol/L. ABG was repeated that showed similar high Lactate level of 16 but lactate level measured on the standard chemistry analyzer showed only mildly elevated plasma lactate (3.2 mmol/L). (Figure 1). Lactate gap was high in both instances. (Figure 2).