Today we discussed the case of a young woman with history of bulimia nervosa and secondary ESRD due to recurrent AKIs, who presented with subacute encephalopathy, found to have metabolic alkalosis with partial compensation with respiratory acidosis in addition to concomitant anion gap metabolic acidosis.

1. Metabolic Alkalosis – due to emesis
2. Respiratory Acidosis- compensatory
3. Anion gap metabolic acidosis – Renal failure, given lactate, and beta-hydroxybutyrate were normal.

In this case, we saw that after SLEDD treatment, patient’s metabolic alkalosis and anion gap metabolic acidosis resolved and she was left with her compensatory respiratory acidosis.

A thanks to former chief resident, Dr. Saloni Kumar for her teaching of this material to us back in 2017!