BACKGROUND In clinical practice, both the history and laboratory testing are paramount to making an accurate diagnosis. Situations in which laboratory findings and patient history are not congruent pose a diagnostic dilemma. We report a case of a young woman presenting with a myriad of electrolyte and acid-base disorders. Difficulty in reaching a unifying diagnosis persisted due to discordant patient history. We believe this case shows that lab findings will clearly portray the problems a patient has and should be given more credence in a case where the history is discordant with lab findings. CASE PRESENTATION A 28-year-old Hispanic American woman presented to the emergency room of our institution with a complaint of painless and sudden onset of stiffness in her upper and lower limbs. Associated weakness worse in the distal limbs was also reported. She experienced shortness of breath with minimal exertion, diaphoresis, and anxiety. Her vital signs revealed tachycardia without corresponding fever. She was conscious, oriented, and alert. Her physical exam revealed dry mucous membranes and warm extremities. She denied recent consumption of a large carbohydrate meal, diarrhea, vomiting, use of laxatives, and use of alcohol or recreational drugs. She vaguely described two previous similar episodes in the last 7 months that spontaneously resolved. Her medical history was significant only for hypothyroidism treated with daily levothyroxine tablets. Laboratory analysis revealed the following abnormalities: an elevated anion gap with significant lactate, hypokalemia, hypomagnesemia, elevated mean corpuscular volume, elevated mean cell hemoglobin, and elevated liver enzymes with aspartate aminotransferase/alanine aminotransferase ratio > 2. She was hydrated with balanced crystalloids, and her electrolyte deficiencies corrected. The etiology of her multiple electrolyte abnormalities was unclear because alcohol use was vehemently denied. Extensive evaluation for causes of electrolyte disorder was undertaken, which was unrevealing. On further interrogation, she admitted to recent alcohol intoxication and several episodes of vomiting before presentation. She was advised to refrain from alcohol use and discharged afterward. CONCLUSION Both patient history and laboratory analysis have a role in identifying and confirming a diagnosis. In cases in which laboratory tests are incongruous with reported history, making a unifying diagnosis can be challenging or delayed. The importance of taking a comprehensive history cannot be overemphasized, but history provided by patients may be prone to intentional or unintentional distortion, whereas laboratory findings are more objective. The case presented underscores why the lab findings should be given credence in cases in which there is discordance between lab results and the provided patient history.

中文翻译：

---

多种电解质失衡和混合酸碱紊乱构成诊断难题：一例病例报告。

背景技术在临床实践中，病史和实验室检查对于做出准确的诊断都是至关重要的。实验室检查结果和患者病史不一致的情况造成诊断难题。我们报道了一例年轻女子的电解质和酸碱紊乱。由于患者病史不一致，难以统一诊断。我们相信这个案例表明，实验室检查结果将清楚地说明患者所遇到的问题，并且在病史与实验室检查结果不一致的情况下应给予更多的信任。病例介绍一名28岁的西班牙裔美国妇女因无痛且突然出现上肢和下肢僵直而出现在我们机构的急诊室。也有相关的无力在远端四肢恶化。她经历了呼吸急促，几乎没有劳累，发汗和焦虑。她的生命体征显示心动过速而未发烧。她有意识，有针对性和机敏。她的身体检查发现粘膜干燥和四肢温暖。她否认最近食用大量碳水化合物，腹泻，呕吐，使用泻药以及饮酒或消遣性毒品。她含糊地描述了过去七个月中自发解决的两个以前的类似情节。她的病史仅对每日服用左甲状腺素片治疗的甲状腺功能减退有意义。实验室分析发现以下异常：带有大量乳酸的阴离子间隙升高，低血钾，低镁血症，平均红细胞体积增加，平均血红蛋白升高，肝酶升高，天冬氨酸转氨酶/丙氨酸转氨酶之比>2。她与平衡的晶体水合，电解质缺陷得到纠正。她的多次电解质异常的病因尚不清楚，因为强烈拒绝饮酒。对电解质紊乱的原因进行了广泛的评估，这是没有发现的。在进一步审问中，她承认最近出现酒精中毒，并在出现前呕吐了几次。建议她不要饮酒，之后应出院。结论患者病史和实验室分析均在识别和确认诊断中起作用。如果实验室检查与所报告的病史不一致，做出统一的诊断可能具有挑战性或延误性。取得全面病史的重要性不能过分强调，但患者提供的病史可能易于有意或无意的扭曲，而实验室检查结果则更为客观。提出的案例强调了在实验室结果与提供的患者病史之间不一致的情况下，为什么应该对实验室检查结果给予信任。