A low serum bicarbonate level, or hypobicarbonatemia, in the presence of a high anion gap typically indicates presence of metabolic acidosis secondary to an increase in unmeasured anions. Herein, we report 2 patients with profound hypertriglyceridemia who presented with low measured serum bicarbonate level and a high anion gap. Further evaluation revealed that the low serum bicarbonate was spurious and resulted from extremely high serum triglyceride levels.
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