01-27-2011, 02:14 PM
@sheeom
read q which is posted at 18 42,and i have already posted ans,b and d.not c because resp acidosis is not combined with mAlkalosis,its a compensation.The motive behind posting this q is to make sure when need to click alone met alkalosis or MA with partial resp acidosis as here,as latter is not in option,so go for former i.e alone M.alkalosis.
When C is true i.e metabolic alkalosis AND resp acidosis in condition like a COPD pt is vomiting,baseline pH can shift from acidotic to alkaline,as he is in M.Alkalosis stage and will be removing more Co2 than his normal high baseline co2 level but still ABG determines resp acidosis.i.e co2 ll be around 45-50.
And resp alkalosis and met acidosis combined processes u can see in salicylates poisoning which comes under TRIPLE ACID BASE DISORDER.i.e Triple RIPPLE as follows
1.salicylate poisoning :-Anion gap metabolic acidosis(from salicylic acid),metabolic alkalosis from vomiting,and primary resp alkalosis(salicylates directly stimulates resp center).
2.Diabetic or alcoholic ketoacidosis:-Non anion gap and anion gap M acidosis(ketoacidosis),M alkalosis(vomiting and hypovolemia) and compensatory resp alkalosis....so in this scenario confusion is ab pH that too i can clear,
in q of alc or diabetic ka,suppose hco3-are very low,and definitely pH ll be very low and resp component is from compensation resp alkalosis...but suppose this pt is vomiting profusely in DKA,then we see HCO3- coming towards normal,it means interpretation is that DK ACIDOSIS setting is superimposed by met.alkalosis due to vomiting.so point of tripple ripple is that sometimes u can also see the hco3- level in DKA pt to be towards normal or slightly increased so don't get confuse,its still DKA with resp compensation.but ans will be then combined met.acidosis+resp alkalosis+m alkalosis,....met acidosis still there in ans,as due to vomiting u still see near normal bicorbonate,because pt is in acidotic state and is just superimposed by vomiting.
don't mess up,if did not get,as its not USMLE going to ask i guess,this stuff u see in AIIMS exams mostly but whatever,it is,best way is to ask and put qs urself ab various scenarios,u ll get the ans urself if u apply logically.
read q which is posted at 18 42,and i have already posted ans,b and d.not c because resp acidosis is not combined with mAlkalosis,its a compensation.The motive behind posting this q is to make sure when need to click alone met alkalosis or MA with partial resp acidosis as here,as latter is not in option,so go for former i.e alone M.alkalosis.
When C is true i.e metabolic alkalosis AND resp acidosis in condition like a COPD pt is vomiting,baseline pH can shift from acidotic to alkaline,as he is in M.Alkalosis stage and will be removing more Co2 than his normal high baseline co2 level but still ABG determines resp acidosis.i.e co2 ll be around 45-50.
And resp alkalosis and met acidosis combined processes u can see in salicylates poisoning which comes under TRIPLE ACID BASE DISORDER.i.e Triple RIPPLE as follows
1.salicylate poisoning :-Anion gap metabolic acidosis(from salicylic acid),metabolic alkalosis from vomiting,and primary resp alkalosis(salicylates directly stimulates resp center).
2.Diabetic or alcoholic ketoacidosis:-Non anion gap and anion gap M acidosis(ketoacidosis),M alkalosis(vomiting and hypovolemia) and compensatory resp alkalosis....so in this scenario confusion is ab pH that too i can clear,
in q of alc or diabetic ka,suppose hco3-are very low,and definitely pH ll be very low and resp component is from compensation resp alkalosis...but suppose this pt is vomiting profusely in DKA,then we see HCO3- coming towards normal,it means interpretation is that DK ACIDOSIS setting is superimposed by met.alkalosis due to vomiting.so point of tripple ripple is that sometimes u can also see the hco3- level in DKA pt to be towards normal or slightly increased so don't get confuse,its still DKA with resp compensation.but ans will be then combined met.acidosis+resp alkalosis+m alkalosis,....met acidosis still there in ans,as due to vomiting u still see near normal bicorbonate,because pt is in acidotic state and is just superimposed by vomiting.
don't mess up,if did not get,as its not USMLE going to ask i guess,this stuff u see in AIIMS exams mostly but whatever,it is,best way is to ask and put qs urself ab various scenarios,u ll get the ans urself if u apply logically.