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Old 08-17-2011
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Question Acid base disorders in these two patients

21-year-old type I diabetic discontinues insulin because of sore throat and difficulty swallowing. Which of the following is the most likely acid-base disorder to develop?
a) metabolic acidosis, normal anion gap
b) metabolic acidosis, increased anion gap
c) acute respiratory alkalosis
d) no acid-base disorder is likely to develop


22-year-old morbidly obese patient adheres to 600 calorie diet, 2000ml waterintake daily for 10 consecutive days. Which of the following is the most likely acid-base disorder to develop?
a) metabolic acidosis, normal anion gap
b) metabolic acidosis, increased anion gap
c) acute respiratory alkalosis
d) no acid-base disorder is likely to develop
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Old 08-17-2011
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I think they are both metabolic acidosis with increased anion gap (ketoacids being the increased anion gap).
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Old 08-17-2011
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I agree. The diabetic patient will develop keto acidosis, and increased catabolic hormone secretion will cause the formation of keto acids.
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Old 08-17-2011
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21-year-old tye I diabetic discontinues insulin because of sore throat and
difficulty swallowing. Which of the following is the most likely acid-base disorder
to develop?
a) metabolic acidosis, normal anion gap
b) metabolic acidosis, increased anion gap
c) acute respiratory alkalosis
d) no acid-base disorder is likely to develop


22-year-old morbidly obese patient adheres to 600 calorie diet, 2000ml water
intake daily for 10 consecutive days. Which of the following is the most likely
acid-base disorder to develop?
a) metabolic acidosis, normal anion gap
b) metabolic acidosis, increased anion gap
c) acute respiratory alkalosis
d) no acid-base disorder is likely to develop
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acr2503 (08-17-2011), Gulara (08-18-2011), riya10 (08-18-2011)
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Old 08-18-2011
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You are correct. the right answer for both questions is metabolic acidosis with increased anion gap.
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Old 08-18-2011
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Help

plz will u explain it????
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Old 08-18-2011
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Anion Gap= = ( [Na+]+[K+] ) − ( [Cl−]+[HCO3−] )

Bicarbonate concentrations decrease, in response to the need to buffer the increased presence of ketoacids... In DM Type 1 because of DKA and in starvation because of beta oxidation of Fatty Acid for energy production.
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Old 08-19-2011
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Quote:
Originally Posted by drnrpatel View Post
Anion Gap= = ( [Na+]+[K+] ) − ( [Cl−]+[HCO3−] )

Bicarbonate concentrations decrease, in response to the need to buffer the increased presence of ketoacids... In DM Type 1 because of DKA and in starvation because of beta oxidation of Fatty Acid for energy production.

Yeah, the accumulation of ketoacids in the first case and fatty acids in the second case will lead to acidosis. These acids will also "be" the anions to replace HCO3- (which will be depleted as a result of buffering) to achieve electroneutrality.
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Old 08-21-2011
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the first case is clearly metabolic acidosis with increased anion gap. But ketoacidosis occurs only in two cases
1) Diabetic ketoacidosis.That too only in type 1
2) Alcoholic ketoacidosis as normal glucose production gets shut off.
So the second person will have ketosis but not acidosis.
Correct me if i am wrong.
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Old 08-21-2011
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AKA is characterized by metabolic acidosis with an elevated anion gap, elevated serum ketone levels, and a normal or low glucose concentration

3 major pathophysiologic causes of the syndrome, which are:
  • Extracellular fluid volume depletion
  • Glycogen depletion
  • An elevated ratio of the reduced form of nicotinamide adenine dinucleotide (NADH) to nicotinamide adenine dinucleotide (NAD+)
The following are the 3 main predisposing events:
  • Delay and decrease in insulin secretion and excess glucagon secretion, induced by starvation
  • Elevated ratio of the reduced form of nicotinamide adenine dinucleotide (NADH) to nicotinamide adenine dinucleotide (NAD+) secondary to alcohol metabolism
  • Volume depletion resulting from vomiting and poor oral intake of fluids
The body decreases insulin activity in the starvation state and increases the production of counter-regulatory hormones such as glucagon, catecholamines, cortisol, and growth hormone. Hormone-sensitive lipase is inhibited by insulin, and, when insulin levels fall, lipolysis is up-regulated, causing the release of free fatty acids from peripheral adipose tissue.
Free fatty acids are either oxidized to CO2 or ketone bodies (acetoacetate, hydroxybutyrate, and acetone), or they are esterified to triacylglycerol and phospholipid. Carnitine acyltransferase (CAT) transports free fatty acids into the mitochondria and therefore regulates their entry into the oxidative pathway. The decreased insulin-to-glucagon ratio that occurs in starvation indirectly reduces the inhibition on CAT activity, thereby allowing more free fatty acids to undergo oxidation and ketone body formation.
Prolonged vomiting leads to dehydration, which decreases renal perfusion, thereby limiting urinary excretion of ketoacids. Moreover, volume depletion increases the concentration of counter-regulatory hormones, further stimulating lipolysis and ketogenesis.



in short there is metabolic acidosis in AKA











Quote:
Originally Posted by mayursn39 View Post
the first case is clearly metabolic acidosis with increased anion gap. But ketoacidosis occurs only in two cases
1) Diabetic ketoacidosis.That too only in type 1
2) Alcoholic ketoacidosis as normal glucose production gets shut off.
So the second person will have ketosis but not acidosis.
Correct me if i am wrong.
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Old 08-21-2011
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Quote:
Originally Posted by Gulara View Post
21-year-old type I diabetic discontinues insulin because of sore throat and difficulty swallowing. Which of the following is the most likely acid-base disorder to develop?
a) metabolic acidosis, normal anion gap
b) metabolic acidosis, increased anion gap
c) acute respiratory alkalosis
d) no acid-base disorder is likely to develop


22-year-old morbidly obese patient adheres to 600 calorie diet, 2000ml waterintake daily for 10 consecutive days. Which of the following is the most likely acid-base disorder to develop?
a) metabolic acidosis, normal anion gap
b) metabolic acidosis, increased anion gap
c) acute respiratory alkalosis
d) no acid-base disorder is likely to develop
b option is better
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Endocrine-, Pathology-, Physiology-, Renal-, Respiratory-, Step-1-Questions

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