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Case Studies on Acid-Base Disorders

Important concepts. -emia refers to a pH-osis refers to an abnormal condition or process. Normal ranges. pH7.36-7.44pCO238-42 mm HgHCO3-22-28 mEq/L. Fact or Fiction?. A pCO2 < 40 mm Hg always implies a respiratory alkalosisFICTION!. Fact or Fiction?. A patient cannot have a metabolic acidosis and a metabolic alkalosis simultaneouslyFICTION!.

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Case Studies on Acid-Base Disorders

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    1. Case Studies on Acid-Base Disorders William T. Browne, M.D.

    2. Important concepts -emia refers to a pH -osis refers to an abnormal condition or process

    3. Normal ranges pH 7.36-7.44 pCO2 38-42 mm Hg HCO3- 22-28 mEq/L

    4. Fact or Fiction? A pCO2 < 40 mm Hg always implies a respiratory alkalosis FICTION!

    5. Fact or Fiction? A patient cannot have a metabolic acidosis and a metabolic alkalosis simultaneously FICTION!

    6. Fact or Fiction? A patient can have a metabolic acidosis with a compensatory respiratory alkalosis FICTION!

    7. Important concepts -emia refers to a pH -osis refers to an abnormal condition or process

    8. Six Steps for Acid-Base Analysis

    9. Six Steps for Acid-Base Analysis

    10. Six Steps for Acid-Base Analysis

    11. Six Steps for Acid-Base Analysis

    12. Six Steps for Acid-Base Analysis

    13. Six Steps for Acid-Base Analysis

    14. Six Steps for Acid-Base Analysis

    15. Problem #1 60 yo male presents to the ED from a nursing home. You have no history other than he has been breathing rapidly and is less responsive than usual. Na+ 123 Cl- 99 HCO3- 5 pH 7.31 pCO2 10

    16. Six Steps for Acid-Base Analysis

    17. Six Steps for Acid-Base Analysis

    18. Six Steps for Acid-Base Analysis

    19. Six Steps for Acid-Base Analysis

    20. Causes of anion gap metabolic acidosis Methanol Uremia Diabetic ketoacidosis Paraldehyde Isopropyl alcohol Lactic acidosis Ethylene glycol Salicylates Rhabdomyolysis

    21. Six Steps for Acid-Base Analysis

    22. Six Steps for Acid-Base Analysis

    23. Causes of non anion gap acidosis with hypokalemia Diarrhea Ureteral diversion Renal tubular acidosis Proximal Distal Mineralcorticoid deficiency Carbonic anydrase inhibitor Acetazolamide Mefenamic acid Post hypocapneic state

    24. Causes of non anion gap acidosis with hyperkalemia Early renal failure Renal disease SLE interstitial nephritis Amyloidosis Hydronephrosis Sickle cell nephropathy Acidifying agents Ammonium chloride Calcium chloride Arginine Sulfur toxicity

    25. Problem #2 42 yo female has the flu for four days with incessant vomiting. She presents to the ED two days after stopping insulin due to no food intake Na+ 130 Cl- 80 HCO3- 10 pH 7.21 pCO2 25

    26. Six Steps for Acid-Base Analysis

    27. Six Steps for Acid-Base Analysis

    28. Six Steps for Acid-Base Analysis

    29. Six Steps for Acid-Base Analysis

    30. Six Steps for Acid-Base Analysis

    31. Six Steps for Acid-Base Analysis

    32. Problem #3 30 year old female BMT patient with neutropenic fever has been receiving multiple antibiotics including amphotericin B. You are called to the bedside for her fevers, rigors, and dyspnea Na+ 125 Cl- 100 HCO3- 8 pH 7.07 pCO2 28 K+ 2.5

    33. Six Steps for Acid-Base Analysis

    34. Six Steps for Acid-Base Analysis

    35. Six Steps for Acid-Base Analysis

    36. Six Steps for Acid-Base Analysis

    37. Six Steps for Acid-Base Analysis

    38. Six Steps for Acid-Base Analysis

    39. If data doesnt make sense, check the validity of your data!

    40. brow2110@umn.edu

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