Low Serum Bicarbonate in a Patient With Diabetes Mellitus:

A 55-year-old woman with a history of insulin-dependent diabetes mellitus was admitted for glucose optimization prior to bilateral salpingo-oophorectomy for ovarian masses. Nephrology was consulted after routine morning laboratory measurements revealed a bicarbonate of 12 mEq/L and an anion gap of 22 mEq/L (Table 1). Inpatient medications included insulin, and acetaminophen as needed. She revealed that a few weeks prior, she was started on a sodium/glucose cotransporter 2 (SGLT2) inhibitor but that she had not taken it in more than 1 week.