Acid-Base Disorders Part II Case #2: 50 year old female with fever and diarrhea of two days duration No previous illness; not on any medicines BP =104/60, HR = 96/minute, RR = 30/min Clear breath sounds Hyperactive bowel sounds
Acid-Base Disorders Part II Case #2: ABGs at RA: pH = 7.30, pCO2 = 20, pO2 = 90, HCO3 = 8 Serum Na = 140 meq/L Serum K = 3.6 meq/L Serum Cl = 124 meq/L Serum HCO3 = 8 meq/L
Acid-Base Disorders Part II QUESTION #1: What is the acid-base disorder present? A.Metabolic acidosis B.Metabolic alkalosis C.Respiratory acidosis D.Respiratory alkalosis
Acid-Base Disorders Part II ANSWER #1: Metabolic acidosis ABGs:pH = 7.30 ( ) pCO2 = 20 ( ) HCO3 = 8 ( ) pCO2 = (1.5 X HCO3) + 8 = (1.5 X 8) + 8 = 20
Acid-Base Disorders Part II QUESTION #2: How will you systematically approach the present acid-base problem?
Acid-Base Disorders Part II QUESTION #3: What is the calculated serum anion gap in this case?
Acid-Base Disorders Part II ANSWER #3: Anion gap = Na – (Cl + HCO3) = 140 – (124 + 8) = 8 ( Normal anion gap metabolic acidosis)
Acid-Base Disorders Part II QUESTION #4: In general, what are the causes of a normal anion gap metabolic acidosis?
Acid-Base Disorders Part II Causes of Normal Gap Metabolic Acidosis I.Gastrointestinal Bicarbonate Losses : diarrhea, small bowel drainage, ureterosigmoidostomy, jejunal loop, ileal loop II.Renal Bicarbonate Losses : Renal Tubular Acidosis Types I, II and IV III.Drugs : K-sparing diuretics, trimethoprim, pentamidine, ACE-I, NSAIDs, cyclosporine IV.Others: Acid loads, ketosis with ketone excretion, expansion acidosis, hippurate
Acid-Base Disorders Part II QUESTION #5: In this particular case, what is the cause of the normal anion gap metabolic acidosis?
Acid-Base Disorders Part II ANSWER #5 : Diarrhea –due to Na and HCO3 losses
Acid-Base Disorders Part III Case # 3: 65 year old male with nausea and severe vomiting of three days duration Also with atopic dermatitis on high dose steroids BP = 90/60, HR= 120/min., RR = 20/min JVP = 4 cm,dry mucosa, clear breath sounds Abdomen distended, active bowel sounds Skin: poor skin turgor, multiple plaques with excoriations
Acid-Base Disorders Part III Case #3: ABGs at RA: pH = 7.50, pCO2 = 56, pO2 = 92, HCO3 = 42 Serum Na = 144 meq/L Serum K = 3.6 meq/L Serum Cl = 81 meq/L Serum HCO3 = 42 meq/L Urine Na = 5 meq/L, Urine Cl = 8 meq/L
Acid-Base Disorders Part III QUESTION #1: What is the acid-base disorder present?