The presence of an unexplained osmolal gap can occur in metabolic acidosis.
Patient selection: osmolal gap
Features:
(1) The patient has an osmolal gap not explained by alcohol or toxic alcohol.
(2) The patient has an increased anion gap.
(3) The patient has lactic acidosis or ketoacidosis.
(4) Inclusion of the concentration of the implicated acid explains the gap.
