Acid-Base Case Studies
The general aim of this handbook is to present a practical approach to the analysis of acid-base problems in the clinical setting with the goal of enabling the clinician to create an acid-base differential diagnosis. The content of the handbook was developed from courses given to medical students, residents, and renal fellows at UCLA. The handbook begins with a review of the concepts required to generate an acid-base differential diagnosis. In the initial chapter, the modified Henderson equation is emphasized. This equation will help the clinician acquire an intuitive understanding of the physiologic interrelationships underlying the pathogenesis of acid-base disorders. The initial chapter also discusses each of the four cardinal acid-base disorders in depth. The goal of this chapter is to introduce the clinician to the essential concepts, which are required to understand acid-base problems. The focus of subsequent chapters is on the approach to interpreting simple and mixed acid-base disorders. Each case is analyzed thoroughly followed by a series of teaching points. Initially, simple acid-base diagnoses are discussed in detail. Mixed acid-base disorders are then thoroughly analyzed. A series of short cases is then presented to help consolidate the concepts learned in the previous chapters. In the final chapter, the interested reader will confront many of the complexities and limitations of current acid-base diagnosis.
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40 mm Hg acid acid-base diagnosis acid-base disorders acid-base disturbance acid-base parameters acid-base rules acute respiratory acidosis acute respiratory alkalosis aldosterone anion gap metabolic anion gap type arterial blood gases beats/min blood bicarbonate concentration blood pressure cause change in HCo3 chapter chronic respiratory acidosis chronic respiratory alkalosis Cl--resistant clinical clinician collecting duct compensated metabolic acidosis cortisol decrease diarrhea distal RTA ethylene glycol fractional excretion gap metabolic acidosis H+ concentration H+ secretion HCo3 hyperkalemia increase ingestion ketoacidosis kidney lab values lactic acidosis meq/L metabolic alkalosis methanol mixed acid-base disorders Non-anion gap metabolic non-gap metabolic acidosis normal anion gap osmolar PCo2 Physical exam revealed proximal RTA proximal tubule pseudohypoaldosteronism type renal bicarbonate renal failure renal tubular acidosis respiratory acid-base disorder respiratory compensation simple acid-base disorders syndrome systemic pH TCo2 TCo2 concentration Teaching points unmeasured anions urine urine anion gap urine Cl volume of distribution