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An acidosis question
28 Oct2009
The patient is a 38 year old man admitted with a bleeding ulcer. It is 3 days later, he is otherwise stable and has these labs. He has known polycystic kidney disease with an estimated GFR of 30. He weights approximately 70 kg.
| Electrolyte panel | |||||
|---|---|---|---|---|---|
| Na | 141 | Cl | 116 | BUN | 49 |
| K | 4.8 | HCO3 | 16 | creat | 2.7 |
| Blood Sugar | 90 |
| ABG | |
|---|---|
| pH | 7.25 |
| pCO2 | 33 |
| pO2 | 83 |
| HCO3 | 15 |
So please address these questions:
1. What is the acid-base disorder?
2. Can you likely confirm the etiology?
3. Would you treat, and how?
4. Will he need long term treatment?
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2 Responses to An acidosis question
Rahul
October 28th, 2009 at 8:29 pm
Hi sir, Is it non anion gap meatbolic acidosis assuming his albumin is normal, with somewhat adequte respiratory compensation..due to renal failure..will treat with HCO3 until symptoms resolve..although he may need long term treatment because he his likely to have CRF due to his PCKD.
Happy Hospitalist
October 30th, 2009 at 11:23 pm
I’m going to guess chronic nongap metabolic acidosis due to his pkd superimposed with a type 4 RTA from his NSAIDs which gave him an ulcer. The narcs for his pain is giving him a relative respiratory acidosis as well