You are answering a USMLE-style medical question. Question: A 55-year-old man presents to his primary care physician for a general checkup. The patient has a past medical history of diabetes, hypertension, and atrial fibrillation and is currently taking warfarin, insulin, lisinopril, and metoprolol. The patient’s brother recently died from a heart attack and he has switched to an all vegetarian diet in order to improve his health. His temperature is 98.6°F (37.0°C), blood pressure is 167/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient’s physical exam is unremarkable. His laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 7,550/mm^3 with normal differential Platelet count: 197,000/mm^3 INR: 1.0 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Which of the following is the best explanation for this patient’s laboratory values? Options: A) Dietary changes B) Increased hepatic metabolism C) Increased renal clearance D) Medication noncompliance Reply with ONLY the letter of the correct answer (A, B, C, or D). No explanation.

A
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