A 7-year-old boy presents to the emergency department with a 5-day history of severe watery diarrhea. His mother reports he has been increasingly lethargic and refusing to drink. On examination, he appears ill with weak, thready pulses and delayed capillary refill. Vital signs: temperature 37.1°C, heart rate 128/min, respiratory rate 28/min, blood pressure 88/52 mmHg. Laboratory studies show: pH 7.18 PCO2 18 mmHg HCO3− 7 mEq/L Na+ 128 mEq/L K+ 2.1 mEq/L Cl− 104 mEq/L BUN 48 mg/dL Creatinine 1.2 mg/dL Glucose 94 mg/dL Urine ketones: negative Which of the following best describes the primary acid-base disturbance?
- A)High anion gap metabolic acidosis from lactic acidosis
- B)Metabolic alkalosis with concurrent respiratory acidosis
- C)Non-anion gap (hyperchloremic) metabolic acidosis with appropriate respiratory compensationGABARITO
- D)Respiratory acidosis with metabolic compensation
- E)Mixed high anion gap and non-anion gap metabolic acidosis
Explicação
This patient has non-anion gap metabolic acidosis with appropriate respiratory compensation. The anion gap is normal: (128 - 104 - 7) = 17 mEq/L (normal 8-16, but within acceptable range given hyponatremia). The metabolic acidosis results from bicarbonate loss... Ver explicação completa e trilha adaptativa →