Ninja Nerd Video Podcast on Acid-Base Disorders

Introduction

• Hosts: Rob and Zach
• Topics: Acid-base disorders including metabolic acidosis (AGMA, NAGMA), metabolic alkalosis, respiratory acidosis, respiratory alkalosis.
• Plan: Discuss 5 cases to understand the disorders better.

Case 1: Anion Gap Metabolic Acidosis (AGMA)

• Patient: 45-year-old female
• Symptoms: Severe abdominal pain, rapid breathing (Kussmaul respirations), confusion, polyuria, polydipsia, nausea, vomiting, fatigue, dizziness
• History: Type 2 diabetes, hypertension, meds: metformin, linil
• Vitals: BP 100/65, HR 120, RR 32, Temp 37.6°C, O2 sat 94%
• Exam: Acutely ill, dehydrated, confused, deep labored breathing
• Labs: Na 138, K 4.5, Creatinine 1.5, BUN 30, glucose 450, bicarb 12, anion gap 30, lactate 5, ketones/high, serum osmolality 330, osmolar gap 10
• ABG: pH 7.1, PCO2 18, PO2 92
• Imaging: Normal abdominal X-ray, clear chest X-ray
• Diagnosis: Diabetic ketoacidosis (DKA) with possible lactic acidosis
• Complications: Respiratory compensation, electrolyte imbalance (hyperkalemia), potential hypotension, arrhythmias
• Treatment: Insulin infusion, fluids to correct volume status, monitor anion gap, avoid bicarbonate unless pH < 7.15

Case 2: Non-Anion Gap Metabolic Acidosis (NAGMA)

• Patient: 62-year-old male
• Symptoms: Progressive weakness, difficulty breathing, increased muscle cramps, frequency of urination, thirst
• History: Chronic kidney disease (CKD) stage 3, GERD, hypertension, meds: calcium carbonate, lenil, amlodipine
• Vitals: BP 145/89, HR 88, RR 24, Temp 37.1°C, O2 sat 96%
• Exam: Fatigued, mild tachypnea, no wheezes/crackles
• Labs: Na 138, K 4, Cl 112, Creatinine 1.8, BUN 29, Bicarb 16, Ca 10.2, Mg 2.1, urine anion gap 20
• ABG: pH 7.28, PCO2 38, PO2 90
• Diagnosis: Likely CKD-related NAGMA
• Differential: RTA types ruled out by potassium and renal function
• Complications: Electrolyte imbalances, particularly potassium shifts
• Treatment: Sodium bicarbonate, treat underlying disease (CKD), monitor GFR

Case 3: Metabolic Alkalosis

• Patient: 48-year-old female
• Symptoms: Nausea, vomiting, weakness, using OTC diuretics for weight loss
• History: Hypertension, self-medicating with HCTZ
• Vitals: BP 100/60, HR 110, RR 18, Temp 36.8°C, O2 sat 97%
• Exam: Dehydrated, tacky, dry mucous membranes
• Labs: Na 140, K 3, Cl 90, Bicarb 36, Creatinine 1.1, BUN 25, urine chloride 15
• ABG: pH 7.52, PCO2 44, PO2 98
• Diagnosis: Vomiting-induced metabolic alkalosis, exacerbated by diuretic use
• Complications: Hypokalemia, dehydration, potential tetany (hypocalcemia)
• Treatment: Discontinue diuretics, IV normal saline, monitor potassium and electrolytes

Case 4: Respiratory Acidosis

• Patient: 68-year-old male
• Symptoms: Increased shortness of breath, coughing, wheezing
• History: COPD, hypertension, former smoker
• Vitals: BP 145/85, HR 102, RR 26, Temp 37.8°C, O2 sat 88% on 2L NC
• Exam: Respiratory distress, wheezes, coarse crackles
• Labs: Na 142, K 4.2, Cl 100, Bicarb 32, BUN 19, Creatinine 1
• ABG: pH 7.3, PCO2 60, PO2 55 on 2L NC
• Diagnosis: COPD exacerbation
• Complications: Chronic CO2 retention, CO2 narcosis, risk of increased ICP
• Treatment: Bronchodilators (albuterol, ipratropium), steroids (methylprednisolone), possible BiPAP, treat underlying cause

Case 5: Respiratory Alkalosis

• Patient: 42-year-old male
• Symptoms: Severe pain, anxiety post-surgery
• History: Anxiety disorder, managed with alprazolam
• Vitals: BP 145/90, HR 102, RR 28, Temp 36.7°C, O2 sat 96% on RA
• Exam: Anxious, in pain, shallow breathing
• Labs: Na 140, K 4.1, Cl 104, Bicarb 22, BUN 14, Creatinine 0.9
• ABG: pH 7.49, PCO2 30, PO2 98 on RA
• Diagnosis: Anxiety and pain-induced respiratory alkalosis
• Complications: Cerebral vasoconstriction, risk of syncope
• Treatment: Anxiolytics, pain management

Conclusion

• Great history and physical exam are crucial in diagnosing acid-base disorders.
• Treat the underlying cause for effective management.
• Ninja Nerd provides comprehensive educational resources for all types of learners.

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