Match each patient's clinical presentation with the most likely acid-base and electrolyte profile expected on their laboratory evaluation.
- A 22-year-old woman presenting with severe, recurrent vomiting due to hyperemesis gravidarum.Hypokalemic, hypochloremic metabolic alkalosis
- A 35-year-old man presenting with volume depletion following 5 days of profuse, watery diarrhea.Normal anion gap metabolic acidosis with appropriately low urine pH and hypokalemia
- A 45-year-old man presenting with altered mental status and acute kidney injury following antifreeze ingestion.High anion gap metabolic acidosis with severe acute kidney injury and crystalluria
- A 28-year-old woman with Sjogren syndrome presenting with recurrent calcium phosphate nephrolithiasis and profound muscle weakness.Normal anion gap metabolic acidosis with inappropriately high urine pH (> 5.5) and hypokalemia
Cevap
The presentations match as follows: Hyperemesis with hypokalemic metabolic alkalosis; Diarrhea with normal anion gap acidosis and low urine pH; Ethylene glycol with high anion gap acidosis; and Type 1 RTA with normal anion gap acidosis and high urine pH.
Understanding the pathophysiology of fluid and electrolyte losses allows for accurate prediction of laboratory panels. Vomiting depletes HCl leading to alkalosis; lower GI losses deplete HCO3- leading to normal AG acidosis with appropriate compensation; toxic alcohols introduce unmeasured anions leading to high AG acidosis; and distal tubular defects prevent H+ secretion leading to normal AG acidosis with inappropriately alkaline urine.
Adım Adım Çözüm
Anahtar Kavram
Pathophysiology and differentiation of acid-base and electrolyte disturbances.