A 55-year-old man comes to the physician for a routine health maintenance examination. He has rheumatoid arthritis and diabetes mellitus. Current medications include lisinopril, metformin, glibenclamide, simvastatin, and aspirin. He drinks 4 beers every evening. Vitals are within normal limits. Examination shows an abdominal bruit. Serum studies are shown:
Na+ 140 mEq/L
K+ 3.8 mEq/L
Cl– 108 mEq/L
HCO3– 20 mEq/L
Glucose 112 mg/dL
Which of the following is the most likely explanation for these findings?
Alcohol use
Crohn disease
Glibenclamide toxicity
Lactic acidosis
Renal tubular acidosis
Salicylate toxicity
