Thought I would share a case that was unusual for me. On my phone, English not my first language, don’t judge me too hard. – let’s go on with the case.
A patient- 83 yo woman – presents with history of diarrhea for 2 weeks. She is hemodynamicaly stable, prerenal acute kidney failure from dehydration GFR 20 ml/min. Contact normal.
In around 6 hours she becomes unresponsive, breathing 25-30 times per minute, kussmaul breathing, cramps in extremities. We do blood gasses and she has severe metabolic acidosis but her kidney function doesn’t really explain the severity of the metabolic acidosis. Her history has nothing that matches with other causes for metabolic acidosis.
After another look at the gasses, her Cl- is really high and her bicarbonate are extremely low.
We start substitution for bicarbonates because we figure she probably has lost them with ongoing diarrhea. After an infuse we re-do blood gasses and her metabolic acidosis has improved a lot, her state is improving quickly as well.
So basically we had hyperchloremic acidosis. But the presentation was unexpected because the kidney function did not really explain the severe metabolic acidosis, the main cause for the severity of her state being the lack of buffer system of bicarbonates.
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