HY USMLE Q #1006 – Metabolic disturbance

A 60-year-old woman is brought to emergency by her husband. She has a 20-year history of hypertension. Current medications include lisinopril, atorvastatin, and aspirin. They live on a farm. Serum studies show:

Calcium                                                                      9.5 mg/dL
Sodium                                                                       137 mEq/L
Potassium                                                                 4.0 mEq/L
Chloride                                                                     104 mEq/L
Bicarbonate                                                             21 mEq/L

Which of the following is the most likely diagnosis?

  Crohn disease
  Ethylene glycol poisoning
  Lactic acidosis
  Renal tubular acidosis
  Salicylate poisoning