A 73-year-old woman is admitted for septic shock due to pyelonephritis. Blood pressure is 78/40 mm Hg despite fluid resuscitation. She is cool and confused. Arterial blood gas shows pH 7.21 and bicarbonate 12 mEq/L. Which of the following is the most likely source of the acid load in this patient?
- A)Loss of gastric hydrochloric acid
- B)Lactic acid production from tissue hypoperfusionGABARITO
- C)Formic acid accumulation
- D)Renal bicarbonate wasting due to aldosterone excess
- E)Hyperventilation-induced carbonic acid loss
Explicação
Poor tissue perfusion in septic shock forces cells into anaerobic metabolism, producing excess lactate and causing a high anion gap metabolic acidosis. The hemodynamic collapse and low bicarbonate strongly support lactic acidosis. Ver explicação completa e trilha adaptativa →