sunny2
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Mr.TunTun Won Ton a very high profile businessman, 56 years is admitted with gross distention of abdomen, and vomiting off and on. He gives a history of gastritis , uncontrolled diabetes and esophageal varices for two years, he drinks Tonny Salker-Black label and Vodka daily, his son was recently admitted with Diabetic Ketoacidosis and his pet had a salicylate intoxication last week, Mrs.TunTun is very worried about her family as she is having recurrent vomiting since this morning after having a session of chemotherapy .Mr. WonTon has bilateral pedal edema and spider angiomas over hands . Which type of acid base disorder is most common in this kind of problem.
1. Metabolic Acidosis
2. Anion gap Metabolic Acidosis
3. Respiratory Alkalosis
4. Metabolic Alkalosis
5. Hypochloreic hypokalemik Met. Alkalosis
6. Respiratory Acidosis
7. Non Anion gap Met.Acidosis
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| rody
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4-METABOLIC ALKALOSIS.....AM I RIGHT??
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| rody
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NO.....I THINK 5 IS THE RIGHT ONE
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| Guptashutosh
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5
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| sunny2
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hmmm, Why - 5 ?
rody , why did you change the answer !!
Guptashutosh , are you sure 
Anybody else with any other choice !!
common ,it's not an exam .....it's yet another intresting concept to learn..
GUESS !!
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| rody
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AS METABOLIC ACIDOSIS HERE DUE TO LOSS OF HCL...AND THERE IS HYPOKALEMIA IN VOMITING
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| rody
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SORRY ....METABOLIC ALKALOSIS
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| Aashi
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5. Ciirhosis with Ascitis ---->secondary hyperaldo--->hypokalemic Metabolic alkalosis
Edited by Aashi on 11/16/06 - 11:03 PM
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| rody
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NO...METABOLIC ALKALOSIS HERE DUE TO VOMITING..CIRRHOSIS CAN LEAD TO RESPIRATORY ALKALOSIS......WHAT IS THE RIGHT ANSWER SUNNY2
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| sunny2
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Ashi, Nice way to think.
rody , Vomiting does present with answer - 5 , but anyway...I would suggest you to please try to go slowly line by line and try to make a sense out of the whole scenario and then write your own final answer with an outline of the basic concept / Logic...it would really help.
Applies to everybody who would like to attempt this question 
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| Aashi
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Okay step by step analysis of each problems sunny
Mrs Tuntunwon ---> recurrent vomiting---->can be 4 /5 in ur choices
Mrs and Mr Tuntunwon son,diabetic ketoacidosis problem---->HAGMA(high anion gap M.acidosis) -->2
Now their hungry dog who gorged on a bottle of ASA---->Mixed ABG -->Met acidosis with resp alkalosis
And If ur pt is Mr.TunWonChin from china,who is a chronic alcholic,with s/s of portal HTN/D.M/and gastrtis s/s --->hez a mix of diseases and and he can 3--->hepatopulmonary syndrome/or chronically hyperventilating like a pregnant lady,or he can have cirrhosis induced seco hyper aldo/or his gastritis induced vomiting---> which can give 4/5,OR he might be presenting with diabetic keto himself which can cause his current s/s ----> Giving a anion gap acidosis
Now u choose sunny who has what...its ur turn to roll the dice...
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| rody
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YES IT IS YOUR TURN SUNNY2
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| sunny2
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Aashi, I did not write that Mr.TunTun Won Ton is from China
what I meant by analysis of the problem is the problem of Mr.Ton, not of his family 
so, what do you think now that Mr.ton is suffering from !!!!
I would surely write the explanation....but I would like that to come from you...as I am sure you know this
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| Aashi
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Well sunny I have already given my explanation abt ur pts family's health conditions and their ABG disorders and abt ur pts condition and the all the possible ABG disorder that ur pt not from 'china' can have..May be once u submit the answer,we can have healthy debate on that...untill then nothin more to add
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| sunny2
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The answer is - 3
Mr.TunTun Won Ton has a chronic Liver diesease with sign and symptom suggestive of chronic liver failure. Patients with chronic liver diesease Most Commonly have Respiratory Alkalosis .
Logic is :-
Chronic Liver disease leads to accumulatiuon of Progestrone in the body which has a stimulatory effect on the Respiratory center that leads to Tachypnoea causing Repiratory Alkalosis.
Other disorder are also possible but their incidence is less then the resp. alkalosis, and yes huge ascitis in pt. with liver failure can also cause resp. alkalosis secondary to resp. embarrasement.
Thanks for the discussion Aashi,rody
Have a nice day !!!
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| Aashi
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Okay that answer was expected...and I did mention that guys with liver disease,coz of acitis will be hyperventilating like a pregnant lady...One more condition ver we get this is hepatic pulmonary syndrome,which is seen with end stage liver disease,secondary hyperaldo causing 4/5 shldnt be missed either..and one more thing to be kept in mind is, this chronic resp alkalosis is ur pts primary ABG disorder,but he shld be having concomittant met alkalosis with or without hypokalemia,if he has too much gastritis induced vomiting,and this is acute and secondary ABG disorder,and this can be excluded out if u do an ABG,until then this shld be in ur differential diagnosis,coz the primary diorder is almost always seen in chronic alkaholics,and the latter is seen more acutely..........kewl...good luck and have a nice day
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| sunny2
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