A 55-year-old man with a history of chronic alcohol abuse comes to the emergency department because of nausea, vomiting, abdominal pain, and altered mental status. He says that he was fired from his job a couple days ago and drank to “drown his sorrows.” He has no significant medical history other than moderate hypertension, for which he takes a ?-blocker. On physical examination, he is tachycardic, is breathing rapidly, and his abdomen is tender throughout. His blood alcohol level is significantly increased. Laboratory studies show:
Na+: 135 mEq/L
K+: 3.3 mEq/L
Cl-: 95 mEq/L
HCO3–: 9 mEq/L
Glucose: 40 mg/dL
Serum pH: 7.1
Lactate: 9.5 mmoL/L
Which of the following metabolic abnormalities is most likely in this patient?
A. Decreased levels of glycerol-3-phosphate
B. Elevated pyruvate levels
C. Inappropriate induction of gluconeogenesis
D. Overproduction of reduced nicotinamide adenine dinucleotide (NADH)
E. Thiamine deficiency
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