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Its pretty easy to work out whats causing the high anion gap (probably the lactate, from hypoperfusion), but the normal anion gap element is a bit mysterious

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Initial management of hyperammonemia The first-line treatment for hyperammonemia consists of stopping all protein intake for 2448 h, while ensuring adequate hydration with high glucose content (dextrose 10%) at 11.5 times maintenance to provide sufficient calories to promote anabolism and reverse catabolism

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