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Question

Difficulty: EasyNephrology

Match each clinical scenario with its most likely primary acid-base disorder.

  • Severe diarrheaNormal anion gap metabolic acidosis
  • Opiate overdoseRespiratory acidosis
  • Protracted vomitingMetabolic alkalosis
  • Salicylate toxicity (early phase)Respiratory alkalosis

Answer

Severe diarrhea causes normal anion gap metabolic acidosis; opiate overdose causes respiratory acidosis; protracted vomiting causes metabolic alkalosis; early salicylate toxicity causes respiratory alkalosis.
Each clinical condition triggers a specific primary acid-base disturbance: bicarbonate loss in diarrhea (normal gap acidosis), CO2 retention in opiate overdose (respiratory acidosis), H+ loss in vomiting (metabolic alkalosis), and hyperventilation in early salicylate overdose (respiratory alkalosis).

Step-by-Step Solution

1
Identify the primary disturbance in severe diarrhea
Normal anion gap metabolic acidosis
Gastrointestinal loss of bicarbonate leads to a non-anion gap (hyperchloremic) metabolic acidosis.
2
Identify the primary disturbance in opiate overdose
Respiratory acidosis
Central respiratory depression leads to hypoventilation and retention of carbon dioxide.
3
Identify the primary disturbance in protracted vomiting
Metabolic alkalosis
Loss of gastric hydrochloric acid and volume contraction leads to metabolic alkalosis.
4
Identify the primary disturbance in early salicylate toxicity
Respiratory alkalosis
Salicylates directly stimulate the medullary respiratory center, causing hyperventilation and blowing off carbon dioxide.

Key Concept

Primary Acid-Base Disorders and Their Etiologies
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Topics

Nephrology

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