Altered mental status and an acid-base disturbance January 2017

In the article “A patient with altered mental status and an acid-base disturbance” (Mani S, Rutecki GW, Cleve Clin J Med 2017; 84:27–34), 2 errors occurred in Table 2. The corrected table appears at left, with corrections shown in red:

View this table:

TABLE 2

‘Rules of 5’ for acid-base problem-solving

In addition, two sentences in the text regarding the osmol gap should be revised as follows:

On page 31, the last 3 lines should read as follows: “When the anion gap metabolic acidosis is multifactorial, as it was suspected to be in a case reported by Tan et al,²³ the osmol gap may be elevated as a consequence of additional toxic ingestions, as it was in the reported patient.”

And on page 33, the last sentence should read as follows: “As reflected in the revisions to MUD PILES and in the newer GOLD MARK acronym, the osmol gap has become more valuable in differential diagnosis of metabolic acidosis with an elevated anion gap consequent to an expanding array of toxic ingestions (methanol, propylene glycol, ethylene glycol, and diethylene glycol), which may accompany pyroglutamic acid-oxoproline.”