ASMPH YL5 Renal Module Small Group Discussion on Acid Base Balance Students Guide: A 50 year old woman,

known diabetic for 8 years is admitted for pallor, easy fatigability, and anorexia. She is on combination of rosiglitazone and metformin, losartan and hydrochlorothiazide. Her blood s gar has been fairly controlled in the last se!eral years b t there has been no check" p for one year now. She also complains of progressi!e bipedal edema for # months. $n %&, patient appears ill, dyspneic, and pale. '% (50)*0, +A, *0)min, ,, -.)min. /eight 0 #5 kg, height 0 5 ft. 1 ngs 0 decreased breath so nds right base. Abdomen 234 fl id wa!e test. %itting edema p to the knees. 1abs are as follows5 +reatinine . mg)dl, '67 .0 mg)dl, +apillary blood gl cose *0mg)dl, Sodi m (-* m&8)1, potassi m 5 m&8)l, +l *-m&8)1, Hemoglobin * gm, Hct 0.-9. 6rine5 Specific gra!ity (.005, 234 - protein, 2"4 s gar, /'+ 50"(-)hpf, ,'+ :"5)hpf, 'acteria plenty. A'; shows5 pH 9.::, p+$- ::mmHg, p$- *0mmHg, H+$: (8m&8)1. Learning O !ecti"es 5 (. <o nderstand the f ndamental physiologic principles behind acid"base homeostasis in o r body. -. <o learn the systematic approach to the e!al ation of acid base disorders #uestions : (. /hat is the relationship of the H+$: and %+$- to the pH = -. /hat are the mechanisms by which the body maintains acid base homeostasis= :. How do alterations in the H+$: and p+$- prod ce and compensate for acid"base disorders = .. /hat degree of compensation is appropriate for each of the primary acid"base disorders = 5. /hat is the sef lness of anion gap in the differential diagnosis =

#. /hat is the approach to the determination of a patient>s acid"base stat s = 9. &xplain the ca se of the acid base dist rbance of the patient.