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Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Acid Base Disorders
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Question 1#Print Question

A 33-year-old woman presents to the primary care physician for a month-long history of palpations and diarrhea. She has no known medical history. She denies taking any prescribed medication and has not traveled anywhere recently; however, she reports being exposed to “lots of sick people” as part of her job as a nurse. On physical examination, she appears anxious, but the rest of her examination results, including vital signs, are within normal limits. Her BMI is 21 kg/m2 . Laboratory studies are as follows:

  • Sodium 139 mEq/L (mmol/L)
  • Potassium 3.6 mEq/L (mmol/L)
  • Chloride 117 mEq/L (mmol/L)
  • Bicarbonate 16 mEq/L (mmol/L)
  • Glucose 135 mg/dL
  • BUN 12 mg/dL
  • Creatinine 0.7 mg/dL
  • Albumin 4.2 g/dL

Which of the following is the MOST likely cause for her laboratory abnormalities?

a. Laxative abuse
b. Bulimia nervosa
c. Factious disorder
d. Exogenous insulin use
e. Diuretic use


Question 2#Print Question

A 43-year-old man is brought by the police to the emergency department after being found unresponsive on the street. He appears unkempt and disheveled. On physical examination, his temperature is 36.0°C, blood pressure is 146/92 mm Hg, pulse rate is 84 beats/min, and respiratory rate is 10 breaths/min. He is not oriented to time and place. Laboratory data show the following:

  • Sodium 144 mEq/L (mmol/L)
  • Potassium 4.3 mEq/L (mmol/L)
  • Chloride 108 mEq/L (mmol/L)
  • Bicarbonate 8 mEq/L (mmol/L)
  • Glucose 135 mg/dL
  • BUN 18 mg/dL
  • Creatinine 1.1 mg/dL
  • Albumin 4.0 g/L
  • Lactate 0.8 mmol/L
  • TSH 3.60 mIU/L

An arterial blood gas is also obtained which shows:

  • pH 7.28
  • pCO2 18 mm Hg
  • plasma osmolality 278 mOsm/kg H2O

Which of the following is the MOST likely diagnosis in this patient?

a. Ethylene glycol poisoning
b. Starvation ketoacidosis
c. Lactic acidosis
d. Isopropyl ingestion
e. Propylene glycol toxicity


Question 3#Print Question

An 87-year-old lady is being evaluated in the nursing home after being found to be more lethargic. She had been complaining of decreased appetite due to abdominal pain and ongoing diarrhea for the last 3 days. Her past medical history is significant for hypertension, type II diabetes mellitus, chronic back pain, and diverticulosis. Her medications include metformin, insulin, lisinopril, and naproxen. On physical examination, her:

  • temperature is 37.8°C
  • blood pressure is 118/82 mm Hg
  • pulse rate is 104 beats/min
  • respiratory rate is 10 breaths/min

Laboratories obtained show the following:

  • Sodium 140 mEq/L (mmol/L)
  • Potassium 3.4 mEq/L (mmol/L)
  • Chloride 99 mEq/L (mmol/L)
  • Bicarbonate 20 mEq/L (mmol/L)
  • Glucose 243 mg/dL
  • BUN 22 mg/dL
  • Creatinine 1.6 mg/dL (baseline 1.1)
  • Albumin 3.7 g/L
  • Lactate 1.0 mmol/L

ABG:

  • pH 7.52
  • pCO2 20 mm Hg

Which of the following is the MOST likely diagnosis in this patient?

a. Metabolic acidosis with compensation
b. Respiratory acidosis with metabolic alkalosis
c. Respiratory alkalosis with increased anion gap metabolic acidosis
d. Respiratory alkalosis with acute compensation
e. Mixed disorder


Question 4#Print Question

A 32-year-old male is referred to the nephrologist for abnormal laboratory values. He was recently seen by his primary care physician for his annual physical examination. During his visit, he was told that his “urine was abnormal.” The patient does not have any known medical history except for a 26-year pack-year smoking history. He is normothermic with a blood pressure of 128/90 mm Hg, pulse rate of 58 beats/min, and respiratory rate of 12 breaths/min. The rest of his physical examination is unremarkable. His family history is only significant for arthritis and “thyroid disease.” Further laboratory studies obtained show the following: 

  • Sodium 142 mEq/L (mmol/L)
  • Potassium 3.3 mEq/L (mmol/L)
  • Chloride 117 mEq/L (mmol/L)
  • Bicarbonate 10 mEq/L (mmol/L)
  • Glucose 243 mg/dL
  • BUN 22 mg/dL
  • Creatinine 1.3 mg/dL (baseline is 1.1)
  • Albumin 4.2 g/L
  • Urine pH 5.6
  • Urine sodium 62 mEq/L
  • Urine potassium 85mEq/L
  • Urine chloride 126 mEq/L
  • Urine calcium 378 mg/dL

What is the MOST likely diagnosis in this patient?

a. Gitelman syndrome
b. Renal tubular acidosis (RTA) type 1
c. RTA type 2
d. Bartter syndrome
e. Salicylate toxicity


Question 5#Print Question

A 64-year-old woman is being treated in the local intensive care unit (ICU) for septic shock due to Streptococcus pneumoniae. She weighs 120 kg. She is started on empiric antibiotics and resuscitated with 30 mL/kg of normal saline without significant improvement. She is therefore temporarily started on vasopressor support. She improves after 4 days and is weaned off all vasopressors. She extubated to noninvasive ventilation. However, her voice remains hoarse, and she fails her swallow evaluation. She remains on intravenous fluids for hydration for 3-day history of diarrhea.

Laboratory data obtained on admission:

What is the MOST likely cause for her laboratory abnormalities?

a. Contraction alkalosis
b. Diuresis
c. Fluid administration
d. RTA
e. Hypoalbuminemia




Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Acid Base Disorders
Page: 1 of 3