luckiest
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what kind of electrolyte disturbances occur in pediatric diarrhea and give example of what it results from?
a)metabolic alkalosis
b)metabolic acidosis ,normal anion gap
c)metabolic acidosis,high anion gap
where is every body by te way? :P
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| drvic
Forum Elite
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Hyperchloremic metablic acidosis, normal anion gap
think of it this way - high anion gap acidosis occurs only when u add some extra anions to the blood (i.e. there are some extra acids in blood). these could be anything - Ethanol, Methanol, ethylene glycol poisoning, lactic acidosis, paraldehyde, NSAIDs etc. (look at the list of High Anion gap acidosis in any textbook, these are the causes usually found; plus starvation and DKA).
actually this topic is too vast to be covered here.
hope this helps somewhat...lemme know if u have further queries
regards
Drvic
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| luckiest
Forum Senior
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Actually the answer is both normal anion gap,high anion gap
a) normal anion gap from losing HCO3 and Cl
b) High anion gap if the hypovolemia uncorrect it can lead to tissue hypoperfusion and lactic acidosis
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| drvic
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such severe lactic acidosis as to cause high anion gap acidosis is unusual and occurs at a very late stage with prolonged severe dehydration, almost pre-terminally. the question here does not quantify the severity of dehydration nor it does it give any info on any patient in particular. so in that case, the general mechanism at work in majority of cases of pediatric diarrhoea is implied, which therefore is normal anion gap acidosis.
However, if u want to take into account all the possible clinical scenarios, then even metabolic alkalosis is possible in pediatric diarrhoea - due to Contraction Alkalosis, secondary to prolonged severe vomiting as part of gastroenteritis
for details you can refer to Nelson Textbook of Pediatrics which also says the same(i.e. normal anion gap acidosis for most cases of diarrhoea in children)
with this approach, u may not be able to answer any question in USMLE, my friend. coz all the choices will seem as possible correct answers to u since the examiners deliberately make the choices seem very close to each other. Remember, the exam is prepared from the point of view of a medical graduate who's just passed out so they're looking for clear cut concepts and not for in-depth hi-fi thread-bare analysis of each question. knowing too little and TOO MUCH - both are bad for this exam!
regards
drvic
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| luckiest
Forum Senior
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Thanks Drvic at first I find this kinda offensive but to think about it I have a very bad skill at doin MCQ so.. I guess I'll take this as improvement :idea:
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| drvic
Forum Elite
Topics: 10
Posts: 181
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hey
i'm sorry if i sounded offensive but my idea was to make you realise the correct approach for solving questions of USMLE. Please read the section in the beginning of Kaplan Qbook where they've discussed in detail the strategy necessary for solving seemingly difficult questions with ease.
apologise sincerely
regards
drvic
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| luckiest
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none offense was taken :wink:
I 'm glad for seeing the pitfall
you should post some topics ! Sounds like you read through pediatrics.
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