18 y/o male high school patient present to ER with headache, confusion, decrease vision, pupil dilation, retinal edema his friend said he's been ill for the past 12-14 hr: His labs: Na 140 Cl 100 K 4 Bicarb 13 Glucose 108 Serum osmo 326 Calculated osmo 291 Ketone negative Ph 7.29 Pco2 26. Which of the following is the cause of his acid base imbalance?
سؤال مجاني 4 من 10 اليوم · اشترك وكمّل بدون حد
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الإجابة: B. Methanol → + affect the vision, high osmolality
AG = 140 − (100 + 13) = 27 (high), ketones negative, and osmolar gap = 326 − 291 = 35 (>10) → high-AG acidosis from a toxic alcohol (methanol/ethylene glycol), treated with fomepizole. Of the options, only methanol fits; ethanol would cause ketoacidosis (ketones are negative), and salicylate/paracetamol do not produce an osmolar gap.
ليش كل خيار صح أو غلط
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A
ليش غلط
Ketoacidosis would show raised ketones (e.g. BHB); this patient's ketones are negative, and a raised osmolar gap points to toxic alcohol instead.
✓ RENAL-01 Acid Base Disorders [Slides].pdf · p. 4 -
B
ليش صح
Methanol is a toxic alcohol (treated with fomepizole), which fits a high-gap metabolic acidosis with an osmolar gap > 10 and negative ketones.
✓ RENAL-01 Acid Base Disorders [Slides].pdf · p. 8 -
D
ليش غلط
In the metabolic acidosis work-up, an osmolar gap > 10 points to toxic alcohol ingestion; his osmolar gap is 326 − 291 = 35, which points away from a non-alcohol cause such as salicylate.
✓ RENAL-01 Acid Base Disorders [Slides].pdf · p. 4
- المصدر
- RENAL-01 Acid Base Disorders [Slides].pdf · p. 4
RENAL-01 Acid Base Disorders [Slides].pdf · p. 8 - المحاضرة
- Respiratory Failure & Acid–Base · Pulmonology · Module B
- ظهر في
- Respi bank