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ACID BASE

ACID BASE. K depletion is most often due to urinary or G I losses What test would you do to differentiate between these tow disorders. Urinary K excretion will be less than 25 meq/day in extrarenal losses.

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ACID BASE

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  1. ACID BASE • K depletion is most often due to urinary or G I losses • What test would you do to differentiate between these tow disorders

  2. Urinary K excretion will be less than 25 meq/day in extrarenal losses

  3. Untreated patients with CHF or cirrhosis are generally normokalemic in spite of secondary hyperaldosteronism Why is that ACID BASE

  4. ACID BASE • A patient with cirrhosis and ascites is admitted to the hospital with acute G I bleed . A portocaval shunt was done . He received 19 units of blood . Ascites was drained but reaccumulated . • pH 7.53 PCO2 50 HCO3 40

  5. ACID BASE • What is responsible for the metabolic alkalosis • What would expect the urine pH and N+ to be • How would you correct the alkalosis

  6. ACID BASE • A 45 year old lady with peptic ulcer disease report 6 days of persistent vomiting BP 100/60 and low JVP • Na+ 140 K+ 2.2 HCO3 42 pH 7.53 • PCO2 53 Cr 1.9 mg/dl • Urine pH 5.0 Na+ 2 K+ 21 Cl- 3 • How would you treat this patient

  7. ACID BASE • Twenty four hours after appropriate therapy HCO3 30 • Urine Na+ 100 K+ 20 Cl- 3 • How would you account for the discrepancy between high urine Na+ and low chloride

  8. A 22 year old woman complain of fatigue and weakness for one year . Physical exam was normal including normal BP • Na+ 141 K+ 2.1 HCO3 45 • Urine Na+80 K+ 170/day • What is the differential diagnosis • What would you order next

  9. Na 140 K 4.2 Cl 114 HCO 3 16 Na 140 K 4.7 Cl 122 HCO3 7 pH 7.32 PCO2 14 The following lab tests are for tow patients would you give Na HCO3 to either one

  10. ACID BASE • A 31 year old man with epilepsy. Lab tests immediately post seizure showed • pH 7.14 • PCO2 45 • Na 140 • K 4.0 • Cl 98 • HCO3 17 • What is the acid base diturbance

  11. ACID BASE • A 58 year old man with COPD develop sever diarrhea lab results • Na 138 • K 3.8 • Cl 115 • HCO3 9 • pH 6.9 • PCO2 40 • What is the acid bse diturbane

  12. ACID BASE • After NaHCO3 administration the patient is still acidotic why ?

  13. ACID BASE • pH PCO2 HCO3 a 7.37 65 37 b 7.22 60 26 c 7.35 60 32 1 a markedly obese 24 year old man 2 A 14 year old girl with acute asthma 3 A 65 year old woman with chronic bronchitis on diuretics

  14. ACID BASE • A 54 year old man with COPD has tow days history of sever dyspnea . CXR showed left lower lobe pneumonia • pH 7.25 • HCO3 30 • PCO2 70 • PO2 30 • Urine Na 4

  15. He was given oxygen and intravenous aminophylin and became unresponsive pH 7.18 PCO2 86 HCO3 31 PO2 62 What s the acid base disturbance What is responsible for the increase CO2 in the hospital If the CO2 is rapidly lowered to 40 what will happen to the pH ACID BASE

  16. ACID BASE • A 65 year old man has a history of smoking and hypertension which is treated with diuretic • pH 7.48 • PCO2 51 • HCO3 36 • PO2 73 • What is the acid base disturbance • Does the patient has significant lung disease

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