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Evaluation into the etiology of her anion gap metabolic acidosis included serum creatinine 0.91 mg/dL, L-lactate 0.8 mmol/L, undetectable D-lactate, undetectable urine ketones and serum salicylates, calculated serum osmolality of 295 mosm/kg, and a measured serum osmolality of 304 mosm/kg

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