Acid Base
Drugs
Arrhythmias
Disorders
Symptoms
100
What is the anion gap for the following patient? Na 137, K 3.8, Cl 98, HCO3 18, BUN 18, Cr 0.9, Glu 120
Na – (Cl + HCO3) = 138 – (98 + 18) = 21 Normal anion gap 8-12 meq/L
100
A 28 y.o. M s/p MVA is brought to the trauma bay. Upon completion of the primary survey, it is noted that the patient desaturates and you initiate rapid sequence intubation. The patient then subsequently goes into cardiac arrest. What agent did you likely use and what stat lab would you order?
Succinylcholine/BMP: hyperkalemia
100
You are called by the nurse regarding a new admission on a critical value for K of 6.9 meq/L. You obtain a stat EKG, what do you expect to see?
Peaked T waves
100
A 45 y.o. F with ESRD is found to have hypocalcemia on routine lab work. What is the physiologic explanation for this?
Vitamin D deficiency: leads to poor gut absorption of calcium
100
A 60 y.o. F recently diagnosed with squamous cell lung carcinoma. The patient presents with nausea, vomiting, abdominal pain and bone pain. What electrolyte abnormality is expected?
Hypercalcemia: stones, bones, groans and psychiatric overtones from paraneoplastic syndrome (PTHrP)
200
A 25 y.o. M is found down and unresponsive. You notice that there is an empty bottle of oxycodone at the scene. What do you expect his ABG will show?
Low pH, high pCO2, normal to high HCO3 Respiratory acidosis with increased renal HCO3 reabsorption
200
A 45 y.o. F works as a chef, presents to you with a burn wound to her left arm. She is allergic to sulfa medications and you prescribe her silver nitrate for local wound care. What electrolyte abnormalities may result from silver nitrate?
Hyponatremia, hypochloremia, hypocalcemia, hypokalemia
200
A 65 y.o. M with ESRD presents to the ED complaining of acute onset perioral numbness and generalized malaise. An EKG is obtained and demonstrates prolonged QT interval and T wave inversion. What electrolyte abnormality is expected?
Hypocalcemia
200
A 54 y.o. M presents to the trauma bay after a fall from a ladder. The patient is amnestic to the event and is noticed to have a SAH that remains on repeat studies. During his ICU stay, the patient is persistently hyponatremic with low urine output. What disorder does the patient present with?
SIADH: treat with water restriction
200
A 42 y.o. F presents with an enlarged goiter requiring a total thyroidectomy. The patient undergoes surgery and stays overnight for observation. On routine blood pressure measurement, the patient’s right hand goes into spasm upon inflation of the cuff. What electrolyte abnormality would you expect?
Hypocalcemia: Trousseau’s sign
300
A 50 y.o. M presents with a partial small bowel obstruction. He was admitted on the red surgery service for conservative management with ngt, bowel rest and ivf. What would you expect to see on his BMP?
Hypochloremic, hypokalemc metabolic alkalosis
300
Shortly after aggressive resuscitation for cardiac arrest, a patient begins to have seizures. What medication could have cause this? a. NaHCO3 b. magnesium sulfate c. epinephrine d. vasopressin
NaHCO3: hypernatremia
300
An EKG was performed that demonstrated flattened T waves and U waves. What electrolyte abnormality is expected on a BMP?
Hypokalemia
300
A 20 y.o. M with a “marfanoid” body build presents with numerous painless nodules of the lips and tongue. You suspect that he has MEN 2B, which is then subsequently confirmed. What electrolyte abnormalities may be seen in this patient?
Hypocalcemia: inhibits osteoclatic bone resorption & Hypophosphatemia: increases renal phosphate excretion and inhibits reabsorption
300
A 40 y.o. pregnant F presents with HTN, visual disturbances, epigastric pain to the ED. Patient is admitted to the OB/GYN unit and a magnesium sulfate infusion started for pre-eclampsia. Her Mg level was measure at 9. What physical sign would prompt you to stop the infusion?
Decreased deep tendon reflexes, respiratory depression
400
Which one of the following conditions would result in the following ABG: pH 7.2, pCO2 25, pO2 90, HCO3 18? a. COPD b. methanol poisoning c. early high altitude exposure d. diarrhea
Methanol poisoning: metabolic acidosis with compensatino (hyperventilation) MUDPILES
400
A 78 y.o. F with a PMHx of CHF was recently started on a new medication. Patient presents to the ED with nausea, vomiting, diarrhea, and blurry yellow vision. What electrolyte abnormality is expected on her BMP?
Digoxin: inhibits Na/K ATPase which leads to indirect inhibition of Na/Ca exchanger leading to increased iCa and hypokalemia
400
A 73 y.o. F presents with recurrent rapid atrial fibrillation. Patient was started on a cardizem gtt, but became hypotensive and the patient was switched to an amiodarone gtt. The nurse pages you because of a continued abnormal telemetry reading. You arrive at bedside and recognize torsades de pointes on the rhythm strip. What medication would you use to treat?
Magnesium sulfate
400
A 22 y.o. F was recently started on lithium for her bipolar disorder and presents with intense thirst and excessive urination. What is the likely cause of this?
Nephrogenic diabetes insipidus: ADH antagonist Serum osmolality > 290 mOsm/L
400
A 35 y.o. M with a PMHx of DM1 was brought in by EMS from work disoriented and in a stupor. The patient complains of some abdominal pain. His glucose upon arrival was 700mg/dL. What is the most likely electrolyte abnormality causing his disoriented state?
Hyponatremia: hyperosmolar hyponatremia due to plasma dilutional effect of hyperglycemia
500
Which renal tubular acidosis disorder presents with a defect in the collecting tubule’s ability to excrete H+. What electrolyte abnormality is associated?
Type 1 (“distal”): hypokalemia
500
A 70 y.o. M was recently started on a new medication for asymptomatic hypercalcemia. He comes back to you because of tinnitus and acute pain in his right great toe. What medication is he taking and what electrolyte abnormality may result?
Lasix: inhibits cotransport system of thick ascending limb (Na, K, 2Cl) resulting in hypokalemia
500
A 45 y.o. F presents with SOB. A CXR is performed and bilateral hilar adenopathy is appreciated. An EKG is performed, and a shortened QT interval was observed. What electrolyte abnormality is expected and why?
Hypercalemia: increase in 1-alpha hydroxylase leading to increased conversion of Vitamin D
500
A 70 y.o. F was brought into the ED from a SNF with altered mental status, lethargy, headache, nausea and vomiting. Patient’s Na on her BMP was 119. Patient was admitted for correction of this. Overnight, the patient presents with acute paralysis, dysarthria, diplopia and loss of consciousness. What was the cause of this?
Central pontine myelinolysis
500
A 55 y.o. F finished her first marathon in Texas, went home and was noticed to be restless, irritable and was brought to the ED by her husband. In the ED she has a seizure. What electrolyte abnormality is expected and how would you treat?
Hypernatremia: Free water deficit = 0.6 x weight x [(Na/140) – 1]
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