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PedsCrit
Acid-Base Diagnosis & Clinical Approach with Dr. Bill Bortcosh--Part 2
Nov 4, 2024
Dr. Bill Bortcosh, a pediatric critical care expert, dives deep into the acid-base status evaluation essential for patient care. He discusses the practical application of the anion gap and how it serves as a vital screening tool. The conversation explores the nuances of fluid management, focusing on the effects of normal saline versus Plasmalite on chloride levels. Bortcosh also addresses the complexities of diagnosing metabolic acidosis, including renal tubular acidosis, emphasizing the importance of continuous learning in navigating these challenges.
39:51
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Quick takeaways
- Accurate evaluation of acid-base disturbances, including non-anion gap metabolic acidosis and renal tubular acidosis, is critical for effective acute patient management.
- Understanding the relationship between chloride loss and metabolic alkalosis helps clinicians prevent complications, particularly during diuretic therapy.
Deep dives
Understanding Non-Anion Gap Metabolic Acidosis
Non-anion gap metabolic acidosis refers to a condition where bicarbonate is lost due to various reasons, rather than an acid being added to the system. This occurs when the body fails to maintain adequate bicarbonate levels, often due to excessive loss through urine or stool. Common causes include hyperchloremia, which can result from the overadministration of saline solutions, prompting the body to excrete bicarbonate to balance chloride levels. Another cause is the use of diuretics like acetazolamide, which inhibits bicarbonate reabsorption in the kidneys, leading to its increased excretion.
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