Which profile is expected when a patient is suspected of alcoholism?

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Chronic alcohol use disrupts liver function and nourishes malnutrition, so the expected lab profile shows signs of both liver enzyme induction and nutritional deficiencies. Ethanol directly raises the serum osmolality gap, so the osmo value tends to be increased. Alcohol metabolism alters the redox state in liver cells, increasing the NADH/NAD+ ratio and driving pyruvate to lactate, which raises lactate levels. Nutrition problems from heavy drinking lead to decreases in albumin and total protein, as well as folate deficiency. Electrolytes are commonly deranged, with potassium and magnesium often low. Putting all of this together, you’d anticipate low albumin and total protein, low folate, low magnesium and potassium, and high GGT, high lactate, high osmolality due to ethanol, and elevated alcohol level. This combination best reflects the profile expected in alcoholism. Other options would have one or more values that don’t align with the effects of alcohol on the liver, nutrition, and metabolism.