luckiest
Forum Senior
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A HIV patient with history of weight loss, Na=160 K =3.5 Cl=115 Hco3=12 glucose=180 Posm=345 what is the differential diagnosis? 
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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BUN = 43 Cr = 2.4
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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choice
a) lactic acidosis
b) ketoacidosis
c) methanol/ethanol poisoning
d) chronic diarrhea
e) RTA
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| bugsbunny
Forum Junior
Topics: 14
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its increased anion gap plus increased sodium...my first choice would be chronic diarrhoea..lactic acidosis also presents with increased anion gap but y would there be increased se Na..RTA ia normal anion gap..pt doest have ketoacidosis....my guess is chronic diarrhoea in HIV+ patient loosing HCO3 n in turn colon absorbs more chlorine..correct me if im wrong.
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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8) What a brilliant answer Bugsbunny!
COrrect the clue of the chronic diarrhea from the history is weight loss (just a clue) then the sign of dehydration from increase Na and the high [cl] from reabsorb like you said .
By the way why do you say there's no ketoacidosis in this patient?
Just wondering .Because I didn't give any clue to rule out.
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| bugsbunny
Forum Junior
Topics: 14
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no ketoacidosis coz first of all it occurs in insulin deficiency with way too much blood glucose levels n counter regulatory hormones then increase gluconeogenesis etc etc which leads to increased substrate for ketone bodies coz insulin is anabolic but counter regulatory hormones r catabolic....n there again wont be increased se Na..but Hyponatremia is more common in AIDS pts.[ just for referance]
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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Actually the answer from the question say:
One of the diff. diag is ketoacidosis cos'
THere are 3 types of ketoacidosis
1. DKA
2.alcoholic ketoacidosis
3.starvaiton ketoacidosis
pathophysiology of 2,3 is there is no glucose and then the body have to catabolize lipid > ketoacidosis
:| But still it doesn't match for high serum sodium like you say. 8)
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| bugsbunny
Forum Junior
Topics: 14
Posts: 54
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hi lucky when r u taking ur step 2? im taking mine in december coz i cant afford it any sooner.
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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HI BUGsBUNNY
I'm still don't have plan the exact date cos' I"m still not finish my school. SO now I'm just studying
:wink: Anything human can imagine is possible
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| bugsbunny
Forum Junior
Topics: 14
Posts: 54
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Hi Lucky
well then u must be applying for 2006 match i guess..im applying for 2005 match but if i cant get matched guess then i'll b trying again next year,,kinda sucks i wasted a year n half after my step 1..where r u from ? im from India but in usa now
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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:lol: THAILAND
Actually I kinda new for USMLE ,SO I must ask u some information.
1. how long does the score can be kept?
2.How much time do u guys actually need to prepare?
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| bugsbunny
Forum Junior
Topics: 14
Posts: 54
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Hi Lucky
well i took my step 1 year n half ago...now they have made it mandatory that u should clear all ur steps in time span of 7 years..so i guess u can keep ur scores till 7 years,,but its better u get them over with coz then u might face difficulty getting into residency..
how much time span needed to study..well depends from person to person,,if u r a recent graduate u might take step1 with 3 months prep or even lesser..i took 3 n half months for step 1..even though i was not a recent graduate but i wish i had more time..its kinda good to get them over with soon coz it gets frustrating..well i began preparing for step 2 in august will take exam on 22nd december so cant say anything abt it until i pass...lol..my score on step 1 was 94..hope it helps
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| luckiest
Forum Senior
Topics: 12
Posts: 82
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THANKS A LOT!
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