Metabolic Acidosis Cases

8/17/2019 Metabolic Acidosis Cases

1/20

METABOLIC ACIDOSIS

CASE STUDY

Hala Kilany, MD.


2/20

CASE-1

• A patient with diahea!-pH"#.$%-HCO%-"1&'e()l-*CO$"$% ''H+


3/20

A patient with diahea ha an ateial pH #.$%,/i0a/nate 0n0entatin 1& 'e(L, and *CO$ $%''H+. The lw pH indi0ate a0ide'ia, and the lwpla'a /i0a/nate 0n0entatin indi0ate 'eta/li0

a0idi. The pla'a /i0a/nate 0n0entatin i 12'e(L /elw n'al, whi0h h3ld lead t a 1# ''H+all in the *CO$ 412 5 1.$ " 1#6 ' 2& t $% ''H+.

Th3, thi patient ha a i'ple 'eta/li0 a0idi. A*CO$ i+ni70antly hi+he than thi le8el w3ld indi0ate a

0n03ent epiaty a0idi. I, n the the hand, the*CO$ wee lwe than $& ''H+, then a 0n03entepiaty al9ali w3ld /e peent, a 'i+ht /e eenwith ali0ylate int5i0atin.


4/20

CASE-$

• A :1 yea-ld 'an pae 3t while waitin+ in theE'e+en0y depat'ent. He i nted t ha8e n p3le

and 0adip3l'nay e30itatin i /e+3n. Initialla/aty data hw!

•

Ateial pH " #.%&Ateial *CO$ " %& ''H+

*la'a di3' " 12& 'e(L*la'a ptai3' " 2.1 'e(L

*la'a 0hlide " 1&& 'e(L

*la'a /i0a/nate " 1: 'e(L• A. ;hat i the a0id-/ae dide<

• B. Cal03late the anin +ap<

• C. ;hat i the 't li9ely dia+ni


5/20

• Thi i a i'ple 0ae hi+h A='eta/li0 a0idi.-A=" 12&-41&&>1:6"$:

-?a)Cl"1.2, in+le dide-*0$! 1.$ 5 @"1&., al't the a'e! %&

• The $ 't e(3ent dia+ni!-Dia/ete-Al0hl int5i0atin


6/20

CASE-%

• A $% yea-ld 'an with n pi hity0'plain ply3ia, plydipia, andplypha+ia $ wee9. He al nte

'e htne /eath. The phyi0ale5a'inatin e8eal a /ld pe3e 1$&& 3pine, @&& tandin+,

in0eaed epiaty ate, andde0eaed 9in t3+. The initialla/aty data e8eal!


7/20

• *la'a di3' " 12& 'e(L*la'a ptai3' " .1 'e(L*la'a 0hlide " 1&& 'e(L

*la'a /i0a/nate " : 'e(L


8/20

• *la'a +l30e " 2& '+dLBU? " 2& '+dL*la'a 0eatinine " 2.$ '+dL

Se3' 9etne " 2> at 1!2 dil3tinUine 9etne " 2>Uine +l30e " 2>

Uine di3' " :% 'e(LUine ptai3' " %$ 'e(L


9/20

• Thi i a 0ae hi+h A= 'eta/li0 a0idi!-A="%:-?a)Cl"1.2! i'ple 0nditin

•;ith the peen0e 9etne in the /dy,thi i dia/eti0 9eta0idi.

• The 3e'ia 'ay /e a 0a3e in the hi+h A=,pe0ially that it ee' t /e a 0hni0 enal

ail3e nt a peenal tate,BU?)Ceatinine"@.:.


10/20

CASE-2

• A 1 yea-ld 0hild wa een /y hi pediati0ian a 3tine e8al3atin and wa 3nd t wei+h 1&9+. Tw day late, he i een in the E'e+en0yDepat'ent diahea and dehydatin. At thi

ti'e, the phyi0al e5a'inatin e8eal!-a p3le 12&, epiaty ate %$'in,

-/ld pe3e @&, and wei+ht.@ 9+. He appea 'deately dehydated with

dy '303 'e'/ane and n tea when he0ied. Thee ae n the i+ni70anta/n'alitie. La/aty data n ad'iine8eal!


11/20

• *la'a di3' " 1% 'e(L*la'a ptai3' " 2.& 'e(l*la'a 0hlide " 1&2 'e(L

*la'a /i0a/nate " 11 'e(LBU? " %$ '+dL*la'a 0eatinine " &. '+dLAteial pH " #.$2

Ateial *CO$ " $2 ''H+Uine pH " :.&Uine pe0i70 +a8ity " 1.&%1


12/20

• ;hat i the a0id-/ae dide<

• ;hat i the anin +ap and whatde it tell y3 a/3t the etil+y the a0id-/ae dide<


13/20

• ?a>)Cl-"1%)1&2"1.%$! hype0hle'i0'eta/li0 a0idi.A="$% hi+h A= 'eta/li0 a0idi

H0%-"$2-11"1%,*CO$ dp h3ld /e!1.$51%"1:. al't $2

• S, it i a 0'/ined 0nditin !-hi+h A= 'eta/li0 a0idi, p/a/ly d3e t

la0ti0 a0idi e0nday t the e8eediahea.-hype0hle'i0 'eta/li0 a0idi, d3e tdiahea.


14/20

CASE-:

• A %1 yea-ld 'an with a hity epilepy ha a +and 'al ei3e.La/aty tet ta9en i''ediately ate

the ei3e ha tpped e8eal!-pH"#.12-*CO$"2:''H+-pla'a F?a>G"12&'e()l

-FK>G"2'e()l-FCl-G"@'e()l-FHCO%-G"1#'e()l


15/20

• ;hat i the a0id-/ae dit3/an0e<

• De the patient need /i0a/nate<


16/20

• Thi i a 0'/ined!-hi+h A= 'eta/li0 a0idi! A=" $:-epiaty a0idi, C&$ i '30h

hi+he than e5pe0ted.• U3ally, nephl+it the 8al3e

a pH"#.$, i a e(3ie'ent

teatin+ the a0idi, 'e eeen0eand t3die dne /y ICU pe0ialit +/elw that, t a 8al3e pH"#.1.


17/20

HY*O?ATEMIA CASES

• Cae-1!A : yea-ld 'an peent t thed0t the 7t ti'e 0'plainin+ ati+3eand wei+ht l. He ha ne8e had any healthp/le', /3t he ha '9ed a pa09 0i+aette pe day a/3t %: yea. He i aday la/e and i 03ently h'ele andli8in+ in a helte. Hi phyi0al e5a'inatin inta/le a lw t n'al /ld pe3e,9in hypepi+'entatin, and di+ital 0l3//in+.He appea e38le'i0. Y3 d 'e /ldtet, and it hwed the llwin+!


18/20

La/ tet

• ?a>"1$'e(l

• K>",#'e(l

• Chlide and /i0a/nate ae lw.

• Ceatinine n'al.• ;hat i y3 dia+ni<

A-SIADHB-hypthyidi'C-=I leD-Adenal in30ien0yE-enal in30ien0y


19/20


20/20

Metabolic Acidosis Cases

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