By Alluru S. Reddi
Written in a succinct query and resolution layout, this entire source covers all components of nephrology and customary medical eventualities. approximately one thousand questions with targeted solutions supply nephrology fellows, practising nephrologists and clinicians a greater realizing of nephrology and relief arrangements for nephrology and inner medication forums. Absolute Nephrology overview positive aspects the newest facts and directions whereas gratifying a serious desire in the nephrology community.
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Additional resources for Absolute Nephrology Review: An Essential Q & A Study Guide
She has also an osmolal gap of 16, which is elevated. The presence of calcium oxalate crystals (envelope-like) in the urine sediment is the clue for her acid–base disturbance, which is ethylene glycol ingestion (B is correct). One of the final products of ethylene glycol is oxalic acid, which is excreted as oxalate. Antidote for ethylene glycol is fomepizole. The initial dose is 15 mg/kg followed by 10 mg/kg every 12 h for 4 doses. Continue fomepizole, if ethylene glycol levels are not below 20 mg/dL.
In Reddi AS. Fluid, Electrolyte, and Acid-Base Disorders. Clinical Evaluation and Management. New York, Springer, 2014, pp. 161–176. 42. A 70-year-old woman with chronic kidney disease (CKD) stage 4 fell and sustained hip fracture. Following hip surgery, she developed watery diarrhea, which did not respond to fasting for 24 h. She complained of abdominal pain. An abdominal X-ray shows dilatation of the colon, and acute pseudo-obstruction (Ogilvie syndrome) was diagnosed. Her stool volume was 876 mL/day.
The anion gap is 20, but osmolal gap is normal. Which one of the following is the MOST likely cause of this acid–base disturbance in this patient? A. L-Lactic acid B. Pyroglutamic acid 1 Fluids, Electrolytes, and Acid–Base Disorders 39 C. D-Lactic acid D. Methanol E. Topiramate The answer is C Except for topiramate, all other causes generate high AG metabolic acidosis. Topiramate causes non-AG metabolic acidosis due to inhibition of carbonic anhydrase. Serum L-lactate is normal; therefore, L-lactic acidosis is excluded.