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What is the answer to the following question? And why?

An untreated patient with which one of the following conditions is MOST LIKELY to present with (relative to a healthy individual) decreased plasma bicarbonate and decreased total body sodium?

  • (a) diabetic ketoacidosis
  • (b) carbon monoxide poisoning
  • (c) anaphylactic shock
  • (d) severe iron-deficiency anaemia
  • (e) a panic attack and hyperventilation
  • 2
    Is this homework? And what steps have you taken to answer this yourself? – Graham Chiu Sep 26 '17 at 5:23
  • 1
    We have a similar rule like Biology that homework questions are off topic. If this is an MCAT question or something that you're looking for clarification on, please specify that. – DoctorWhom Sep 28 '17 at 7:00
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Carbonic Acid / Bicarbonate Buffer System

CO2 + H2O ↔ H2CO3 ↔ H+ + HCO3


Metabolic Acidosis and DKA


Includes the following:

  • Decreased pH

  • Low HCO3 levels

  • This condition occurs when acids other than carbonic acid accumulate in ECF or when there is a loss of HCO3.

  • Rarely occurs spontaneously but in is with other problems (starvation, shock, trauma... but the answer you're looking for is.......


ANSWER

Diabetic Ketoacidosis (DKA)


Key Points (Information Below MerekManual Professional Version)


  • Metabolic acidosis can be caused by acid accumulation due to increased acid production or acid ingestion; decreased acid excretion; or GI or renal HCO3− loss.
  • Metabolic acidoses are categorized based on whether the anion gap is high or normal.
  • High anion gap acidoses are most often due to ketoacidosis, lactic acidosis, renal failure, or certain toxic ingestions
  • Normal anion gap acidoses are most often due to GI or renal HCO3− loss
  • Calculate delta gap to identify concomitant metabolic alkalosis, and apply Winters formula to see whether respiratory compensation is appropriate or reflects a 2nd acid-base disorder.
  • Treat the underlying cause
  • NaHCO3 is indicated when acidosis is due to a change in HCO3− (normal anion gap acidosis)
  • Intravenous NaHCO3 is controversial in high anion gap acidosis (but may be considered when pH < 7.00, with a target pH of ≤ 7.10).

Sources:

http://www.webmd.com/diabetes/tc/diabetic-ketoacidosis-dka-topic-overview#1

http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/metabolic-acidosis

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