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

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

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

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

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

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

 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

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

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

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

ACID BASE  After NaHCO3 administration the patient is still acidotic why ?

ACID BASE  pH PCO2 HCO3 a b c 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

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

ACID BASE  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  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