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tachycardia, tachypnoea, altered level of consciousness presence of risk factors features of underlying cause INVESTIGATIONS high anion gap metabolic acidosis (HAGMA) on blood gas normal osmolar gap normal lactate normal beta-hydroxybutyrate high pyroglutamic acid (urine or blood) MANAGEMENT stop exacerbating factors treat sepsis, including: early and appropriate antibiotics source control supportive care and monitoring intubation, ventilation, renal replacement therapy (RRT) as indicated N-acetylcysteine help replenish glutathione stores References and Links LITFL Metabolic Muddle 004 Staph sepsis and an unusual metabolic acidosis Journal articles Dempsey GA, Lyall HJ, Corke CF, & Scheinkestel CD (2000)