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Exploring a case of a patient with a complicated anion gap metabolic acidosis, discussing the controversy around using sodium bicarbonate, the indications for fomepizole, and the importance of building a therapeutic relationship with ED patients. Also covers the initial steps in managing severe renal failure and metabolic acidosis, the lack of evidence supporting bicarbonate use, treatment of hyperkalemia and anion gap metabolic acidosis, and the potential causes of anion gap metabolic acidosis.
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Quick takeaways
- Considering a differential diagnosis of metabolic acidosis using the mnemonic 'Gold MARK' instead of 'MUDPILES' can help identify potential causes.
- Building a therapeutic relationship with patients and families is crucial in guiding clinical decisions, even in emergency situations where patients may be strangers.
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Case presentation of a 66-year-old woman with lethargy and weakness
The case involves a 66-year-old woman who presented with a 10-day history of lethargy, weakness, decreased PO intake, non-bloody stools, and intermittent abdominal pain. The patient had a medical history of type 2 diabetes, gout, hypertension, atrial fibrillation, stroke, congestive heart failure, and chronic alcohol use. Physical examination revealed normal vitals, except for abdominal tenderness. However, blood work showed severe renal failure, hyperkalemia, metabolic acidosis, and a wide-end QRS on ECG.
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