A 52 year old man is found at home hypotensive and confused.In the ED,his blood pressue is 82/60 mm Hg and his HR is 115/min.He is confused and lethargic.Laboratory data show:
Na+=133 meq/L
K+=2.4 meq/L
CL-=70 meq/L
Hco3-=50 meq/L
BUN=44 mg/dl
Creatinine-1.7 mg/dl
An ABG shows:
Po2=62 mm of Hg
Pco2=49 mm of Hg
pH=7.66
What acid base disorder is present?
A.Anion gap metabolic acidosis
B.Metabolic acidosis
C.Metabolic alkalosis plus respiratory acidosis
D.Respiratory acidosis
E.Respiratory alkalosis
What is the most likely cause of the acid base disorder for the patient in the preceding scenario?
A.Acute myocardial infarction
B.Cushing syndrome
C.Mineralorticoid excess
D.Vomiting
E.Bartter syndrome
here again same example of scenario which i posted in last acid base Q,where i did one correction,you first better check that new explanation post before doing this Q,that way it would be easy.
Now read this Q,not the one posted in above column,because while writing i made an option wrong in choice B,its M.alkalosis in place of M acidosis.
HERE WE GO...once again
A 52 year old man is found at home hypotensive and confused.In the ED,his blood pressue is 82/60 mm Hg and his HR is 115/min.He is confused and lethargic.Laboratory data show:
Na+=133 meq/L
K+=2.4 meq/L
CL-=70 meq/L
Hco3-=50 meq/L
BUN=44 mg/dl
Creatinine-1.7 mg/dl
An ABG shows:
Po2=62 mm of Hg
Pco2=49 mm of Hg
pH=7.66
What acid base disorder is present?
A.Anion gap metabolic acidosis
B.Metabolic alkalosis
C.Metabolic alkalosis plus respiratory acidosis
D.Respiratory acidosis
E.Respiratory alkalosis
What is the most likely cause of the acid base disorder for the patient in the preceding scenario?
A.Acute myocardial infarction
B.Cushing syndrome
C.Mineralorticoid excess
D.Vomiting
E.Bartter syndrome
Alright, here what I think. First look at the pH which is in the alkaline range. Now look at the HCO3 which is extremely high while PaCO2 is slightly high, which means it metabolic alkalosis.
Now let us calculate the anion gap, u will get 13 which is normal AG.
Let us check question 2:
If we look quickly at BUN/Cr ration, we find it more than 20 times, which means, pt is suffering from pre-renal hypovolemia. Cl is very low, and pH is high, pt most probably is suffering from severe vomiting.
Any comments.
Yeah,its due to vomiting,u figured out rightly so,so but ab first one,what is the ans there.
So, the answers are B and D
To neverlate
AG is a measure of unmeasured anion seen in metabolic acidosis and not in Metabolic alkalosis.
In metabolic alkalosis there is nothing like AG.
ans is C and E
HERE is my explanations ..
Bartter syndrome is a rare inherited defect in the thick ascending limb of the loop of Henle. It is characterized by low potassium levels (hypokalemia), decreased acidity of blood (alkalosis), and normal to low blood pressure. There are two types of Bartter syndrome: neonatal and classic. A closely associated disorder, Gitelman syndrome, is milder than both subtypes of Bartter syndrome.
People suffering from Bartter syndrome present symptoms that are identical to those of patients who are on loop diuretics like furosemide.
The clinical findings characteristic of Bartter syndrome are hypokalemia, metabolic alkalosis, and normal to low blood pressure.
These findings may also be caused by:
Chronic vomiting: These patients will also have low urine chloride levels
Abuse of diuretic medications (water pills): The physician must screen urine for multiple diuretics before diagnosis is made.
Magnesium deficiency: These patients will also have low serum and urine magnesium
what do u say friends?