Case #4
A 29 year-old male with a history of Type I diabetes mellitus is seen in your office for a routine insurance examination.
On physical exam he is a well-developed, well-nourished male in no apparent distress. Blood pressure 110/70, pulse 76, respirations 26 and he was afebrile. HEENT was grossly unremarkable. Cardiopulmonary exam had a normal S1 and S2 without S3, S4 or murmur. The abdomen was benign with normoactive bowel sounds. Extremities were without cyanosis, clubbing or edema.
Laboratory Data
|
Chemistry |
Normal Values | Arterial Blood Gas | Urine | |
| Sodium | 140 | 136-146 mmol/L | pH 7.35 PC02 30mmHg P02 105mmHg bicarbonate 16mmol/L |
pH 5.5 |
| Potassium | 6.4 | 3.5-5.3 mmol/L | ||
| Chloride | 112 | 98-108 mmol/L | ||
| Total C02 | 16 | 23-27 mmol/L | ||
| BUN | 44 | 7-22 mg/dl | ||
| Creatinine | 2.5 | 0.7-1.5 mg/dl | ||
| Glucose | 110 | 70-110 mg/dl | ||
Questions
1. What is the primary acid-base abnormality?
2. Calculate his anion gap. Is there an increase in the anion gap?
3. He has nonanion gap metabolic acidosis. What is the hydrogen ion concentration?
4. Is there a compensatory mechanism for this abnormality?
5. What is the predicted compensatory response?
6. Is this disorder simple or mixed?
7. What are the common causes for non-anion gap metabolic acidosis?
8. What clinical condition(s) is (are) responsible for the acid-base disturbance in this patient? Explain your logic.
9. What are the physiologic mechanisms responsible for the generation of this disturbance?