Acid-Base & Lytes

Acute kidney injury

June 14, 2011

  A 60+ year old man was admitted for a 1 day history of abdominal pain, hematochezia, and a rash developing over his lower extremities bilaterally.  No significant PMH other than chronic pain. H&P revealed a history of nausea and vomiting the day previous to admission with 6 bright red bloody stools and diffuse abdominal [...]

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Predict the numbers (electrolyte panel)

June 2, 2011

60-year-old man admitted for 3-5 days of nausea, vomiting (undigested food), watery diarrhea (volume not specified) and alcohol on his breath. Patient has significant orthostasis with pulse increase (just raising head of bed).  PMH of hypertension – only prescribed metoprolol. Predict the electrolyte disorders and acid base disorders. There are no surprises here – we [...]

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Saline is not always the answer

March 18, 2011

Happy Hospitalist enjoys interpreting arterial blood gases.  I wonder if he enjoys electrolyte panels as much.  I do love lab test interpretation (all lab tests) because as a diagnostician (med talk for detective) I want to take advantage of every possible clue. Extreme Metabolic Alkalosis: Classic Blood Gas Physiology Management Simply Explained\ We become really [...]

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The acidotic patient – my teaching points on management

February 21, 2011

50-something year-old woman is admitted for weakness.  She has a history of chronic diarrhea.  She has had type II DM for over 15 years.  Her labs are remarkable: Fluid Balance Panel 137 113 48 163 5.6 14 1.5   Arterial Blood Gas pH 7.24 pCO2 36 pO2 79 c HCO3 16 What do you think [...]

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Why the patient is acidotic – 2 of 3?

February 20, 2011

50-something year-old woman is admitted for weakness.  She has a history of chronic diarrhea.  She has had type II DM for over 15 years.  Her labs are remarkable: Fluid Balance Panel 137 113 48 163 5.6 14 1.5   Arterial Blood Gas pH 7.24 pCO2 36 pO2 79 c HCO3 16 What do you think [...]

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Why is this patient acidotic?

February 18, 2011

Presented this week at morning report: 50-something year-old woman is admitted for weakness.  She has a history of chronic diarrhea.  She has had type II DM for over 15 years.  Her labs are remarkable: Fluid Balance Panel 137 113 48 163 5.6 14 1.5   Arterial Blood Gas pH 7.24 pCO2 36 pO2 79 c [...]

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The challenging acid-base case – my opinions

January 26, 2011

The most important teaching point here is that the markedly elevated phosphate explains the increased anion gap.  I have probably seen this about 4 times in the past 5 years.  I agree with the comments that the FeNa is very high, suggesting acute tubular necrosis.  The rapid correction suggests that the patient was in the [...]

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Challenging acid-base Part 3

January 25, 2011

To recount:     Na 124 Cl 71 BUN 99 glu 114 K 5.5 CO2 31 creat 6.6       ABG on room air pH 7.46 pCO2 18 pO2 70 calc HCO3 13 Step 1 Define the acid-base problem. Several readers understood that the ABG does not fit the BMP.  Let us start with [...]

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Challenging acid base problem – part 2

January 21, 2011

To recount:     Na 124 Cl 71 BUN 99 glu 114 K 5.5 CO2 31 creat 6.6       ABG on room air pH 7.46 pCO2 18 pO2 70 calc HCO3 13 Step 1 Define the acid-base problem. Several readers understood that the ABG does not fit the BMP.  Let us start with [...]

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A very challenging acid base problem from morning report

January 19, 2011

They saved this one for me for 6 months!  Here is the intro as written by an excellent resident: 52 yo WM with hx of heroin use presented to ER from jail for AMS, nausea, vomiting, and diarrhea.  Pt was arrested 2 days prior to presentation, and per guard had been somewhat confused but ambulating [...]

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