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  What explains her normal anion gap?
  A malnourished 32-year-old female with Crohn’s disease is brought to the emergency department following a spontaneous out-of-hospital cardiac arrest. After bystander cardiopulmonary resuscitation (CPR), she is intubated and resuscitated with three rounds of CPR, including two doses of epinephrine. Following the return of spontaneous circulation (ROSC), she remains hypotensive and requires vasopressors. The first arterial blood gas (ABG) obtained following ROSC shows a pH of 6.99, pCO2 of 55 mm Hg, pO2 of 142 mm Hg, and a bicarbonate (HCO₃) of 11 meq/L. An initial lactate level is 9 mmol/L. Serum electrolytes show a sodium of 126 mmol/L, chloride of 105 mmol/L, bicarbonate of 11 meq/L, and her anion gap is 10 mmol/L.
  Which of the following explains her normal anion gap?
  • Hypoventilation causing a respiratory acidosis
  • Bicarbonate depletion via gastrointestinal tract
  • Low serum albumin
  • Normal saline used in resuscitation

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