|
Anion gap metabolic acidosis
|
|
|
#
|
Anion gap = sodium – (chloride + bicarbonate)
—
(Normal: 10-14)
|
|
Causes
|
MUDPILES
|
|
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol/paraldehyde
Isoniazid/iron
Lactic acidosis
Ethylene glycol (antifreeze)
Salicylates (aspirin)
|
|
MUDPILES
|
|
|
DKA
|
DM
⊕ Ketones
Tx: IVF, Insulin, K+
|
|
Methanol
|
Causes blindness
Has no cure
|
|
Ethylene Glycol
|
⊕ Urine crystals
urine turns color under wood’s Lamp
Give either ethanol or fomepizole
|
|
Lactic Acidosis
|
If pt is in shock → Tx the shock
|
|
Types of IVF
|
||
|
Tonicity
|
Type
|
Used in
|
|
Isotonic
|
0.9% NS
|
Volume resuscitation
|
|
Lactated Ringer
|
Volume resuscitation
|
|
|
Albumin (5% or 25%)
(Colloid Solution)
|
Volume replacement,
Tx of SBP or HRS
|
|
|
Hypotonic
|
Dextrose 5% in water
|
Free-water deficit
|
|
0.45% (half-normal) saline
|
Free-water deficit
|
|
|
Dextrose 5% in 0.45% (half-normal) saline
|
Maintenance hydration
|
|
|
Hypertonic
|
3% (hypertonic) saline
|
Severe hyponatremia
|
Fast HY Review 