Differential Diagnosis

The patient's laboratory results and clinical presentation suggest several possible diagnoses. Here's a categorized differential diagnosis:

• Single most likely diagnosis

  • B. Anion gap acidosis: The patient's CO2 level is low (19 mmol/L), indicating a metabolic acidosis. Although the anion gap is not directly calculated, the presence of metabolic acidosis in the context of heavy alcohol consumption suggests an anion gap acidosis, possibly due to ketoacidosis or lactic acidosis.

• Other Likely diagnoses

  • C. Hepatitis: The patient's AST (27 U/L) and ALT (34 U/L) are slightly elevated, which could indicate liver inflammation or injury, possibly due to alcohol consumption. However, the elevations are not significantly high to strongly suggest acute hepatitis.
  • A. Renal insufficiency: The patient's creatinine level is slightly elevated (1.1 mg/dL), which could indicate some degree of renal impairment. However, this finding alone is not sufficient to confirm renal insufficiency.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Alcoholic ketoacidosis with severe metabolic acidosis: Although the anion gap is not directly calculated, severe metabolic acidosis can be life-threatening and requires prompt treatment.
  • Ethylene glycol or methanol poisoning: Although not directly suggested by the laboratory results, these conditions can present with metabolic acidosis and would be deadly if missed.

• Rare diagnoses

  • Other causes of anion gap acidosis, such as lactic acidosis due to sepsis or salicylate poisoning, although less likely, should be considered in the differential diagnosis.
  • Wilson's disease or other rare liver disorders, which could cause abnormal liver function tests, although unlikely in this clinical context.