W******g
发帖数: 143 | 1 What’s kind of acid-base imbalance the patient has?
60 y.o. AAM c history of HTN, alcoholism presents with dizziness, and
hemoptysis for 2 days. The last drinking was 3 days ago. on admission,
hypotensive, tachcardia and orthostasis, pale. Otherwise normal.
Lab Na 137, Cl 97, K 3.6, CO2 18, BUN 12 Cr o.8, Glu 83, Ca 8.4
ABG on RA 7.40(PH)/30(PCO2)/87(PO2)/18.8(HCO3)
Explain the acid base disorder please. | H****J
发帖数: 22 | 2 anion gap metabolic acidosis with respiratory alkalosis compensation | W******g
发帖数: 143 | 3
Nice try! please try harder!
This is a real case I had while on call. I presented it on the morning
report.
【在 H****J 的大作中提到】
: anion gap metabolic acidosis with respiratory alkalosis compensation
| a*********d
发帖数: 2763 | 4 acid base,rule of thumb是，one will never over correcting himself.这个PCO2按
照HCO3的降幅来说好像太低了一点了哈。
ABG on RA 7.40(PH)/30(PCO2)/87(PO2)/18.8(HCO3) | s*******r
发帖数: 174 | 5 when there is a gap, we always want to calculate deltaAG, in this case, he
has a gap of 22, deltaAG+bicarb>expected, he also has met alkalosis. by
winter fomula, his co2 should be 35+-2 when compensated, his co2 is 30 now,
so he has rep alkalosis. with a normal PH, he has AG met acidosis, resp
alkalosis and met alkalosis.
【在 W******g 的大作中提到】
:
: Nice try! please try harder!
: This is a real case I had while on call. I presented it on the morning
: report.
| u***e
发帖数: 611 | 6 厉害哦，这些我也只在书上看到过，现实中从来不会去算它。那这个病人酸碱失衡你们
会去治疗吗？要我就给点fluid就好了，病人肾功能正常应该自己会纠正过来吧。
,
【在 s*******r 的大作中提到】
: when there is a gap, we always want to calculate deltaAG, in this case, he
: has a gap of 22, deltaAG+bicarb>expected, he also has met alkalosis. by
: winter fomula, his co2 should be 35+-2 when compensated, his co2 is 30 now,
: so he has rep alkalosis. with a normal PH, he has AG met acidosis, resp
: alkalosis and met alkalosis.
| s*******r
发帖数: 174 | 7 我是noon conference 上学来的；）AG代酸要找原因吧，alcoholic这么大gap,搞不好
喝点儿ethylene glycol 啥的。
。等wanking下回分解。。
【在 u***e 的大作中提到】
: 厉害哦，这些我也只在书上看到过，现实中从来不会去算它。那这个病人酸碱失衡你们
: 会去治疗吗？要我就给点fluid就好了，病人肾功能正常应该自己会纠正过来吧。
:
: ,
| l******e
发帖数: 14 | 8 Good tip! I thought met acidosis plus resp alkalosis first, so my initial
impression was to rule out ASA toxicity.
Now with met alkalosis, it becomes interesting.
So, if ever AG is increased, we have to calculate delta-delta, which equals
to delta AG/delta bicarb. if delta-delta is between 1-2, it's only AG met
acidosis; less than 1, then AG and non-AG met acidosis at the same time;
greater than 2, it's AG meta acidosis and met alkalosis.
Since this patient presented with dizziness, being hypote
【在 s*******r 的大作中提到】
: when there is a gap, we always want to calculate deltaAG, in this case, he
: has a gap of 22, deltaAG+bicarb>expected, he also has met alkalosis. by
: winter fomula, his co2 should be 35+-2 when compensated, his co2 is 30 now,
: so he has rep alkalosis. with a normal PH, he has AG met acidosis, resp
: alkalosis and met alkalosis.
| l******e
发帖数: 14 | 9 Actually, he had hemoptysis in the past two days.
How about septic shock caused by pneumonia? | W******g
发帖数: 143 | 10 Good, Have a wonderful weekend. By the way, Is it interesting?
I give that. Always look for the cause of AG Met acidosis.
Do you guys need another case? | H****J
发帖数: 22 | 11 Nice to discuss some real stuff. thanks for your input. |
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