Clinical Communication to the Editor
Spurious Low Serum Bicarbonate Level Due to Severe Hypertriglyceridemia: A Clinical Challenge

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Case Reports

The first patient is a 48-year old man with a history of chronic pancreatitis secondary to severe hypertriglyceridemia. He was admitted for acute pancreatitis and was found to have a serum triglyceride level of 3267 mg/dL. He had normal renal function and electrolytes, but hypobicarbonatemia of <5 mmol/L was reported on chemistry panel with an anion gap of >28. However, arterial blood gas revealed absence of acidemia with pH 7.4, PCO2 35, PO2 84, and bicarbonate 23, suggesting presence of

Discussion

Accurate assessment of bicarbonate is essential for the diagnosis of acid-base disturbances. Bicarbonate can be “measured” in serum as total carbon dioxide (tCO2) or “calculated” from arterial blood gas analysis (Henderson-Hasselbalch equation). In most instances, tCO2 and bicarbonate are closely related due to the constancy of the apparent dissociation constant of blood carbonic acid (pK′). Presence of a marked difference between the 2 values creates a clinical challenge that should prompt

References (3)

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Cited by (3)

  • Mind the gap: A case of unexplained elevated anion gap without concomitant metabolic acidosis

    2023, Journal of the National Medical Association
    Citation Excerpt :

    When serum bicarbonate levels were verified using an arterial blood gas, hypobicarbotinemia was revealed as artificial in all cases. Furthermore, in cases caused by lipemic interference, treating the hyperlipidemia corrected the serum bicarbonate level.5 The two cases came to medical attention for acute pancreatitis secondary to hypertriglyceridemia.

  • Severe hypertriglyceridemia causing pseudo-acidosis: a case report

    2022, Research Square

  • Severe Hypertriglyceridaemia Leading to Factitious Hypobicarbonataemia

    2021, European Journal of Case Reports in Internal Medicine

Funding: No specific financial support was obtained for preparation of this article.

Conflict of Interest: The authors have no conflict of interest regarding the content of this manuscript.

Authorship: Both authors had access to the data and a role in writing the manuscript.

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