A 28-year-old woman with a 6-month history of Crohn's disease presents with persistent diarrhea. She reports approximately 4-6 loose stools daily but denies vomiting or recent antibiotic use. Vital signs are stable: BP 110/68 mmHg, HR 92 bpm, RR 18 breaths/min, temperature 37°C. Laboratory studies show: pH: 7.32 PaCO2: 35 mmHg HCO3−: 16 mEq/L Serum K+: 3.2 mEq/L Serum Cl−: 92 mEq/L Serum Na+: 138 mEq/L Anion gap: 8 mEq/L Which of the following best explains the pathophysiologic mechanism underlying this patient's acid-base disturbance?
- A)Loss of gastric HCl with contraction metabolic alkalosis
- B)Accumulation of lactate and ketoacids from malabsorption
- C)Normal anion gap metabolic acidosis from bicarbonate wasting in stool with secondary hyperchloremiaGABARITO
- D)Respiratory acidosis from diaphragmatic weakness secondary to hypokalemia
- E)Impaired renal ammonia excretion leading to hyperammonemia-induced acidosis
Explicação
This patient has a normal anion gap (non-anion gap) metabolic acidosis. The mechanism is loss of bicarbonate in diarrheal fluid. In inflammatory bowel disease, particularly Crohn's disease with chronic diarrhea, the terminal ileum and colon (which normally rea... Ver explicação completa e trilha adaptativa →