Severe Hypertriglyceridaemia Leading to Factitious Hypobicarbonataemia

Anion gap metabolic acidosis is a laboratory finding commonly encountered in patients with sepsis, diabetic ketoacidosis, acute kidney injury and toxic alcohol ingestion. Serum blood chemistry assessment detects this abnormality. However, this can be falsely low in situations of high triglyceride levels due to lipid interference with measurement of the bicarbonate levels and through volume displacement by these large molecules. Arterial blood gas analysis and a lipid panel are required to confirm accurate bicarbonate levels. Clinicians handling acid-base disorders in hospitalized patients need to be aware of this spurious laboratory value to avoid unnecessary tests and to determine accurate total bicarbonate levels. LEARNING POINTS: Elevated triglycerides can cause spurious low blood bicarbonate levels. High anion gap metabolic acidosis is associated with serious clinical illness which can lead to a battery of diagnoses and therapeutics. Accurate knowledge of this condition with falsely low bicarbonate levels will prevent unnecessary medical work-up and guide prompt treatment.