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  #1  
Old 02-25-2012
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Question How to investigate this alkalosis?

A 35-year-old male who works as a nurse in local hospital is brought to the emergency room with confusion and lethargy. His temperature is 36.7C (98F), blood pressure is 86/48 mm Hg, pulse is 120/min, and respirations are 12/min. Arterial blood gas reveals pH 7.59, pCO2 49 mmHg and pO2 85 mmHg. Which of the following is most useful in diagnosing the cause of this patient's condition?
A. Serum osmolarity
B. Serum sodium
C. Serum ketones
D. Urine glucose
E. Urine chloride


Explain ur self please
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  #2  
Old 02-25-2012
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Default Serum Sodium

I guess serum sodium (lethargic, alkalotic patient)
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Old 02-26-2012
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alkalosis with low bp

must be contraction alkalosis...high aldosterone...low serum sodium

check his serum sodium??whats the ans?
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Old 02-26-2012
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contraction alkalosis due to fluid loss(dehydration,diuretics..)
so check for hypernatremia?
answer please
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Old 02-26-2012
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just checked cmdt
its written to check urine chloride in order to differentiate between alkalosis due to gain in bicarb or lack of loss of bicarb.

wtf
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Old 02-26-2012
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check urine chloride levlel
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  #7  
Old 02-26-2012
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E. urine chloride?
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  #8  
Old 02-27-2012
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Default s sodium

i think serum sodium , low bp, lethargy, primary aldosteronism?
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  #9  
Old 02-27-2012
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will go with urine chloride..the man is hypoventilating...po2 low and pco2 high..so there is increase to compensate for respiratory acidosis..and HCO3- will increase...and with an anion gap lowering and chloride concentration we can get the HCO3- increase and providing for the diagnosis and paradoxical increase in blood ph
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Old 03-01-2012
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OMG... After long time I got it and understand it ... The patient it's acidotic, doubt about it. I found the explanation in the Constanzo Pag.173-174 5th edition.

In the metabolic acidosis the correction consist in increased excretion of Excess H fixed as tritatable acid and NH4 and increased reabsorption of new HCO3 who replenish the ones used to buffering the fixed H.

The serum anion gap : [Na] - [Cl + HCO3] as the serum HCO3 decrease as its depleted in buffering fixed acid, another anion must increase to replace it and maintain the electroneutrality. It could be one of the unmesured one (protein, phosphate, citrate, sulfate) or can be Cl. So we don't just check the anion gap, because it just tell us if it's a hyperchloremic metabolic acidosis or not, but we need to check the urine Cl to confirm it.
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Old 03-01-2012
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Default Alkalotic

Yes but the patient is alkalotic not acidotic
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Old 03-01-2012
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Jaja sorry it must said was... My bad ... almost try
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