Here a collection of our #AcidBase Twitter Polls (and the answers!):
Poll #20:
What’s the most likely case of the #acidbase disorder (s) here:
-pH 7.25, PCO2 30 mm Hg, PO2 88 mm Hg
-Na 141 meq/L, K 3.7 meq/L, Cl 108 meq/L, HCO3 12 meq/L
-BUN 12 mg/dL, glucose 99 mg/dL
-Serum osm 333 mosm/kg
-Albumin 4 mg/dLhttps://t.co/YMbaMhjhSn#pLACO 🧪— NephSIM (@Neph_SIM) February 15, 2020
Answer: IV diazepam
p: Acidemia
L: Low PCO2, low HCO3 –> Primary metabolic acidosis
A: 141 – 108 – 12 = 21 (normal = 10, albumin 4 g/dL)
C: Expected PCO2 = 1.5 (12) + 8 = 26 (28 – 30) –> Adequate respiratory compensation
O: Calculated osm = 2*Na + glucose/18 + BUN/2.8 = 2 (141) + 99/18 + 12/2.8 = 292
Serum osm – calculated osm = 333 – 292 = OSMOLAL GAP!
Propylene glycol (present in formulations of intravenous diazepam) cause an elevated anion gap metabolic acidosis AND and increased osmolal gap. Isopropyl alcohol does NOT increase the anion gap, but does increase the osmolal gap.
Poll #19:
What’s the most likely etiology of the #AcidBase disturbance (s) here?
pH 7.5, PCO2 48, PO2 85
Na 143, Cl 98, HCO3 36 , glucose 95, BUN 12
Albumin 4
Serum osm 295 https://t.co/YMbaMhjhSn— NephSIM (@Neph_SIM) February 9, 2020
Answer to our last #acidbase poll: primary hyperaldosteronism (Conn Syndrome)
Alkalemia ➡️ elevated bicarbonate + PCO2 ➡️ primary metabolic alkalosis with appropriate resp compensation
No osmolal gap ➡️ unlikely to be isopropyl alcohol https://t.co/YMbaMhjhSn#pLACO 🧪 https://t.co/H7PJcOKPGQ
— NephSIM (@Neph_SIM) February 12, 2020
Poll #18:
What’s the most likely explanation for the PRIMARY #acidbase disorder below?
pH 7.45, PCO2 19, O2 80
Na 137, Cl 116, HOC3 17, K 4.1, Cr 1.2
Urine Na < 20, Cl < 20, K 21 https://t.co/YMbaMhjhSn— NephSIM (@Neph_SIM) January 20, 2020
Answer:
p: Alkalemia
L: Low PCO2, low HCO3 –> Primary respiratory alkalosis –> Decompensated cirrhosis
Poll #17:
Happy New Year! Our resolution: more cases. 🥳
Here’s an #acidbase case to get 2020 started:
pH 7.3, pCO2 30
Na 135, Cl 106, HCO3 16, K 6.5, Cr 1.0
Albumin 4Urine: pH 6, Na 50, K 60, Cl 30
What’s the most likely diagnosis?https://t.co/YMbaMhjhSn
— NephSIM (@Neph_SIM) January 2, 2020
Answer:
p: Acidemia
L: Low PCO2, low HCO3 –> Primary metabolic acidosis
A: 135 – 106 – 16 = 13 (normal = 10, albumin 4 g/dL)
C: Expected PCO2 = 1.5 (16) + 8 = 32 (28 – 30) –> Adequate respiratory compensation
O: No osmolality provided, Delta/Delta = 3/8 –> suggests presence of non-anion gap metabolic acidosis
Urine anion gap: Na (50) + K (60) – Cl (30) = (+) –> suggests kidney bicarbonate wasting –> RTA
Of the answers provided, hyperkalemia suggests a type 4 RTA
Poll #16:
What’s the most likely etiology of the #AcidBase disorder here?
pH 7.23, pCO2 30, pO2 80
Na 140, Cl 100, HCO3 14
Lactate 1.0, albumin 4 https://t.co/YMbaMhjhSn#FOAMed— NephSIM (@Neph_SIM) December 9, 2019
Answer to our last #AcidBase poll: acetaminophen, which can lead to a 5-oxoproline AG metabolic acidosis (AG 26 here) 💊
Remember: isopropyl alcohol does NOT raise the anion gap, it only raises the osmolal gap https://t.co/YMbaMhjhSn#pLACO #FOAMed https://t.co/Xb8iXUyn59
— NephSIM (@Neph_SIM) December 12, 2019
Poll #15:
What’s the most likely cause of the #AcidBase disorder here?
Na 133, K 4.1, Cl 93, HCO3 4
Cr 2.8, Osm 330
pH 7.07, pCO2 13, pO2 55
Lactate 1, albumin 4https://t.co/YMbaMhjhSn#FOAMed— NephSIM (@Neph_SIM) November 12, 2019
Answer to our last #AcidBase poll: ethlyene glycol
1. Acidemia, low HCO3 ➡️metabolic acidosis
2. Anion gap = 36 (normal 4 * 2.5 = 10)
3. ❄️expected pCO2 = 1.5 (4) + 8 = 14, adequate resp compensation
4. Osmolal gap ➡️alcohol ingestionhttps://t.co/YMbaMhjhSn#FOAMed #pLACO pic.twitter.com/S95TSSZrVv— NephSIM (@Neph_SIM) November 15, 2019
Poll #14:
Which of the following most likely caused the #AcidBase disorder (s) below:
pH 7.35, pCO2 27, O2 88
Na 136, Cl 112, HCO3 14
Cr 1.5, albumin 4, glucose 85
Serum osm 290https://t.co/YMbaMhjhSn#FOAMed #pLACO— NephSIM (@Neph_SIM) October 23, 2019
Answer to last #AcidBase poll:
pH 7.35, pCO2 27, O2 88
Na 136, Cl 112, HCO3 14, albumin 4
Serum osm 2901⃣ Acidemia, ⬇️ HCO3
2⃣AG 10, NORMAL (albumin 4)
3⃣Exp pCO2 = 27 – 31
4⃣No osm gap = not alcohol ingestion💩➡️ Non-AG Metabolic Acidosishttps://t.co/YMbaMhjhSn#FOAMed
— NephSIM (@Neph_SIM) October 25, 2019
Poll #13:
Which #AcidBase disorders are present here?
pH 7.26, pCO2 23, paO2 88
Na 135, Cl 89, HCO3 10
Albumin 4AGMA = anion gap metabolic acidosis
Met alk = metabolic alkalosis
Resp alk/acid = respiratory alkalosis/acidosis https://t.co/YMbaMhjhSn#FOAMed— NephSIM (@Neph_SIM) October 2, 2019
Poll #12:
The most likely etiology of the #AcidBase disorder (s) below:
pH 7.12, pCO2 28, O2 94
Na 148, K 4, Cl 115, HCO3 10
Albumin 4Urine Na 42, K 18, Cl 85https://t.co/YMbaMhjhSn#pLACO
— NephSIM (@Neph_SIM) September 13, 2019
Answer to our last #AcidBase poll: #methanol
-Acidemia ➡️ anion gap (23) met acidosis + resp acidosis
-Of the choices, salicylates 💊& methanol ⬆️ AG
-Salicylate AGMA often associated w/ resp alkalosis 2/2 🧠medulla stimulation ➡️ hyperventilationhttps://t.co/YMbaMhjhSn
— NephSIM (@Neph_SIM) September 16, 2019
Poll #11:
What’s the most likely etiology of the #AcidBase disturbance (s) below:
pH 7.28, pCO2 29, O2 93
Na 139, Cl 115, HCO3 14, Cr 1.2
K 3.9
Albumin 4
Urine Na 42, K 18, Cl 85https://t.co/YMbaMhjhSn#FOAMed #pLACO— NephSIM (@Neph_SIM) September 3, 2019
Answer to our last #acidbase poll:
NonAG metabolic acidosis
Urine anion gap = Na + K – Cl = (-), suggests lower GI loss 💩💩💩Urine Cl is used as surrogate measure of NH4+ excretion
Of note: UAG is variable in T2 RTA as ammoniagenesis is not impaired.https://t.co/YMbaMhjhSn
— NephSIM (@Neph_SIM) September 5, 2019
Poll #10:
Which of the following is most likely to lead the #acidbase disturbance (s) here:
pH 7.3, pCO2 25, O2 90
Na 140, Cl 100, HCO3 12
BUN 28, glucose 180, Cr 1.1
Serum osm 290 https://t.co/YMbaMhjhSnWe’ll send lanyards to the first 10 to DM us the right answer#FOAMed #pLACO
— NephSIM (@Neph_SIM) August 21, 2019
Answer to our last #AcidBase poll
Chronic #acetaminopen use 💊 (oxoproline or pyroglutamic acidosis)
Normal osm (so not alcohol), AGMA w/ AG 2️⃣8️⃣ w/ adequate respiratory compensation (not salicylates). BZD overdose may produce a respiratory acidosis. https://t.co/YMbaMhjhSn
— NephSIM (@Neph_SIM) August 23, 2019
Poll #9:
What’s the most likely ingestion here?
Na 145/K 4.8/Cl 111/HCO3 15
BUN 56/Cr 2.3/Glucose 180
Albumin 4pH 7.2/pCO2 30
Serum osmolality: 444 mosm/kg https://t.co/1ZfVvS7yOT#AcidBase #FOAMed #NBLUniv @NBLUniv— NephSIM (@Neph_SIM) August 9, 2019
Poll #8:
What’s the most likely ingestion here?
Na 135/K 4.8/Cl 111/HCO3 14
BUN 28/Cr 1.1/Glucose 180
Albumin 4pH 7.2/pCO2 32
Serum osmolality: 333 mosm/kg https://t.co/YMbaMhjhSn#AcidBase #FOAMed— NephSIM (@Neph_SIM) July 31, 2019
Poll #7:
Which #AcidBase disorder(s) are present here, if any?
pH 7.35, pCO2 27, pO2 90
Na 136, K 3.6, Cl 112, HCO3 14
Albumin 4 https://t.co/YMbaMhjhSn#pLACO #FOAMed— NephSIM (@Neph_SIM) July 3, 2019
Poll #6:
What’s the most likely cause of the #acidbase disorder here?https://t.co/YMbaMhjhSn
pH 7.24/pCO2 22 / pO2 92
Na 138/ Cl 102/ HCO3 15
Albumin 4 #pLACO— NephSIM (@Neph_SIM) June 19, 2019
Poll #5:
What’s the most likely cause of the #acidbase disturbance below? #pLACO
pH 7.33/pCO2 65/lactate 1.1
Na 143/Cl 103/HCO3 32
Albumin 4 https://t.co/YMbaMhjhSn— NephSIM (@Neph_SIM) May 30, 2019
Poll #4:
#AcidBase Answer:https://t.co/YMbaMhjhSn
1. Primary process: respiratory #alkalosis, as pH 7.39 and pCO2 39
2. Bicarb 22, AG 21. Delta AG is 11, so there is both an AGMA and metabolic alkalosis. #pLACO https://t.co/fpudXNhOQl
— NephSIM (@Neph_SIM) May 21, 2019
Poll #3:
The answer to our #acidbase last poll:
We have a non-anion gap metabolic acidosis, positive urine anion gap, #hypokalemia, & alkaline urine…
Suggestive of a Type 1 #RTA.#pLACO: https://t.co/YMbaMhjhSnhttps://t.co/I3UNyo2Q9j
— NephSIM (@Neph_SIM) May 15, 2019
Poll #2:
What’s the #acidbase disturbance in this patient with an acute pulmonary embolism? #pLACO
pH 7.50/pCO2 20/pO2 60
Na 139, Cl 109, HCO3 20 https://t.co/YMbaMhjhSnAGMA = anion gap metabolic acidosis
— NephSIM (@Neph_SIM) April 26, 2019
Poll #1:
What’s the most likely cause of the #acidbase disorder in our Case 18 patient with the labs below?
pH 7.24 / pCO2 22 / pO2 92
Na 138 / Cl 102 / HCO3 15https://t.co/3T98mxU4Tj #PainRegion #NephMadness— NephSIM (@Neph_SIM) April 3, 2019
The answer to our last poll:
An anion gap metabolic #acidosis and a respiratory alkalosis, classic presentation of #salicylate toxicity
Our #acidbase tutorial and mnemonic #pLACO: https://t.co/YMbaMhjhSn#FOAMed https://t.co/iJUacnNYrh
— NephSIM (@Neph_SIM) April 4, 2019