Acid-Base & Lytes

An acid-base question

February 9, 2012

35-year-old man admitted for worsening ascites. We know the patient because he had just left AMA 3 days before.  He had HIV with a low CD4 and did not take any anti-retrovirals.  He also had hep C cirrhosis with encephalopathy and worsening ascites.  He did take spironolactone and lactulose and the lactulose was causing diarrhea. [...]

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VA Dec 2011 – day #3 – my thoughts on the acid-base problem

December 18, 2011

  50 something patient with combination of restrictive and obstructive disease.  This electrolyte panel caught everyone's attention. 139 91 25 3.0 42 1.2 ABG pH 7.45 pCO2 59 pO2 59 Bicarb 41 What likely happened to this patient?  What do you want to do now? An elevated bicarbonate suggests two possibilities – metabolic alkalosis or [...]

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VA Dec 2011 – day #2 – an acid-base problem

December 17, 2011

50 something patient with combination of restrictive and obstructive disease.  This electrolyte panel caught everyone's attention. 139 91 25   3.0 42 1.2   ABG pH 7.45 pCO2 59 pO2 59 Bicarb 41 What likely happened to this patient?  What do you want to do now?

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November acid-base – final thoughts

November 25, 2011

  50 something woman admitted for nausea and recurrent vomiting and right flank pain.  She denies hematemesis or melena.  She smokes 1 pack per day and drinks 8-9 beers per day.  She is thin, weighing around 54 kg. Labs are drawn, and the patient is admitted. 125 73 15 49 2.8 8 0.6 Your job [...]

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November acid-base part 2

November 17, 2011

  50 something woman admitted for nausea and recurrent vomiting and right flank pain.  She denies hematemesis or melena.  She smokes 1 pack per day and drinks 8-9 beers per day.  She is thin, weighing around 54 kg. Labs are drawn, and the patient is admitted. 125 73 15 49 2.8 8 0.6   Your [...]

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November acid base electrolyte quiz

November 15, 2011

50 something woman admitted for nausea and recurrent vomiting and right flank pain.  She denies hematemesis or melena.  She smokes 1 pack per day and drinks 8-9 beers per day.  She is thin, weighing around 54 kg. Labs are drawn, and the patient is admitted. 125 73 15 49 2.8 8 0.6   Your job [...]

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Electrolyte disorders – need your opinion

September 15, 2011

I am giving a talk at the ACP meeting this coming year on dangerous electrolyte disorders.  Please vote on which disorders I should emphasize. My current plans include: Hyponatremia Hypophosphatemia Hypercalcemia but I am still considering Hypokalemia Hyperkalemia Hypomagnesemia   I need your help – what disorders would interest you most?

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Metabolic disarray – understanding and treating the hyponatremia

September 3, 2011

Now obviously this is my opinion, and other may differ. We have an alcohol abusing woman who presented with a Na of 110 mEq/L and depressed mental status.  She awoke as saline increased her sodium quickly to 120 mEq/L.  This occurred because her urine osms of 150. This patient admitted to a beer diet.  Her [...]

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Metabolic disarray – more information

September 1, 2011

To recap:   47-year-old woman found stuporous and hypotensive.  She has known alcohol abuse and decreased LVEF around 30%.   Her labs come back, and you should provide plausible reconstructions of these results. Fluid Balance Panel  110 59 38 73 3.2 30 2.2 8.0 Arterial Blood Gas on 2L nasal oxygen pH 7.57 pCO2 31 [...]

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Metabolic disarray

August 30, 2011

47-year-old woman found stuporous and hypotensive.  She has known alcohol abuse and decreased LVEF around 30%.   Her labs come back, and you should provide plausible reconstructions of these results.   Fluid Balance Panel  110 59 38 73 3.2 30 2.2 8.0   Arterial Blood Gas on 2L nasal oxygen   pH 7.57 pCO2 31 [...]

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