Factitious acidosis and severe hypoalbuminemia caused by unsuspected assay interference

It is relatively common to have some discord between laboratory biomarkers and clinical status. The current practice of medicine relies on imaging and biochemical testing in order to guide decision-making. In the clinical setting, an unsuspected laboratory artifact can have harmful impacts on patients. These circumstances can invariably lead to misdiagnoses, unnecessary testing and inappropriate treatments. We present a case of very low serum bicarbonate (4 mmol/L) in concert with a very low albumin level (0.3 g/dL). It turned out that the lab measurements were erroneous and a lot of harmful interventions could have ensued when dealing with this peculiar case.