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Acid/Base Disorders - Differentials
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Metabolic Acidosis    - anion gap =    (Na+) - ([Cl-] + [HCO3-])
Increased anion gap >15   : MUDPILES
Methanol, Uremia, DKA, Alcoholic KA, paraldehyde, phenformin, Iron, Isoniazide, Lactate (CO, cyanide), Ethylene Glycol,  Salicylates
 
Normal anion gap  <15:  (hypercloremic acidosis) 
       
           LOW POTASSIUM
GI loss of HCO3, diarrhea
pancreatic fistula
renal HCO3 loss, Type 2 (proximal) RTA, Type I (distal)RTA
Renal dysfunction
Some cases of renal failure
Myeloma
hyperglobulinemia
Hypoaldosteronism (type 4 RTA)
hyperventilation
Ingestions - Ammonium chloride, acetazolamide, hyperalimentation fluids, some cases of ketoacidosis, particularly during treatment with fluid and insulin, heavy metals (Pb,n Cd, Hg, Cu)
chronic pyelonephritis
obstructive uropathy
drugs (ampho, Li)
autoimmune (SLE, Sjogren's, thyroiditis, hyperglobulinemia, cryoglobulinemia, chronic active hepatitis, amyloidosis)
medullary sponge kidney
 
           NORMAL or ELEVATED Potassium
early renal failure
hyperalimentation
post-hypocapneic
aldosterone deficiency
Addison's
Type IV RTA
aldosterone resistance
obstructive uropathy
sickle cell disease
amyloid
SLE
analgesic nephropathy
 
 
 
Metabolic Alkalosis
     a. Chloride-responsive (urine Cl <10); vomiting, NG drainage, diuretics, post-pypercapneic, cystic fibrosis, villous adenoma, congenital chloride diarrhea
     b. Chloride-resistant (urine Cl >20); primary aldosteronism, secondary aldosteronism (CHF, cirrhosis & ascites, Cushings, Bartter's) congenital adrenal hyperplasia, Liddle's, licorice
     c. Miscellaneous: poorly resorbed anion (PCN, carbenicillin), refeeding alkalosis, administration of alkali (e.g. antacis, overshoot from Rx of acidosis, massive transfusions with citrate anticoagulant, milk alkali)
 
 
 
Respiratory Acidosis
respiratory center inhibition (opiates, myxedema, O2 in CO2 retainer),
neuromuscular disorder (Guillain-Barre, myathenia gravic, botulism, hypokalemia),
chest wall disorder,
airway obstruction,
acute and chronic lung disease
Respiratory Alkalosis
CNS disorders,
hypoxia,
pulmonary receptor stimulation (asthma, pneumonia, pulmonary edema, PE, anxiety)
drug (ASA, theo),
cirrhosis,
sepsis,
recovery phase of metabolic acidosis