neuroblastoma
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First ,i dont get you..if you can rephrase ur question or may be i am poor on reading it.
well, my lil understanding says---H,K,Cl loos in vomiting causing hypochloremic alkalosis,so thats why low urine chloride.
NaCL we give for dehydration. so it means low sodium and chlorides at time of dehydration
Increased urine chloride excretion may be caused by:
Increased salt intake
Postmenstrual diuresis
Pharmacologic diuresis
Salt-losing nephritis
Adrenocortical insufficiency
Decreased urine chloride excretion may occur with:
Decreased salt intake
Adrenocortical hyperfunction
Extrarenal fluid loss (such as diarrhea, vomiting, sweating, and gastric suction)
Salt retention
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| neuroblastoma
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Chloride-responsive alkalosis (extrarenal chloride loss)
Causes include recurrent vomiting, gastric acid loss, diuretic-induced alkalosis (loop or thiazide diuretics), and posthypercapnic metabolic alkalosis.
CLD, cystic fibrosis, and laxative abuse are also potential causes.
Chloride-resistant alkalosis (with either euvolemia or hypovolemia)
Renal chloride wasting, as well as severe potassium and magnesium depletion, may occur in patients with Bartter syndrome and rarely Gitelman syndrome.
Chloride-resistant alkalosis may result from acute administration of exogenous alkali, as in patients with milk-alkali syndrome or following massive blood transfusion.
Rare cases include hypercalcemia due to vitamin D toxicity and hyperparathyroidism and nonreabsorbable anions.
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| cool doctor
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I dont know if I understand your Q
but simply vomiting causes HCL loss from the stomach
I dont think this is what u need??
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| Lim
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oh..that's it. i'll post the Q tomorrow.
i tried to exract low chrolide from hypokalemic alkalosis. i was wrong.
vomitting just make it low chloride. thanks.
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| Lim
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A 20-year-old white female presents with polyuria,polydipsia,weakness and fatigue. Her past medical history is insignificant. She has been smoking a pack of cigarettes for the last two years and drinks alcohol on weekends. She denies the use of any drugs. Her mother is diabetic and her father died of MI at 40. Her pulse is 74/min/m, BP is 110/70 nad Temp is 37.2 C. Lab shows plasma glucose of 90 mg/dl, plasma sodium of 140 meq/L, potassium of 2.2 meq/L and bicarbonate of 42 meq/L. There is increased plasma renin activity with increased plasma aldosterone. Urine assay for diuretics is negative. Urine chloride concentration is 45meq/L(normal= 80~250meq/L). Based on these findings, What is the most likely diagnosis in the above patient?
A. primary hyperaldosteronism
B. Diuretic abuse
C. Bartter's syndrome
D. Surreptitious vomitting
E. Renin secreting tumor
how could you move to the right answer in this question with ruling out distractors?
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| titly
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is it bartters syndrome or surreptitious vomiting
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| tamerbashir
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SURREPTITIOUS VOMITING
GIVE ME UR ANSWER DR DARKHORSE
WHAT IS THE BARTTERS SYND.
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| cool doctor
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I think its bartter
in vomiting the urine chloride is <10, thats what I know
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| plastic_surgery
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It can not be Bartter's syndrome as it is seen new borns and infants.. Bartter's presents with dehydration and Renin is not high..
It must be vomiting.
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| doyoudig
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ok Rule out B -- B/c Urine negative for diuretics
R/o A -- B/c Renin is also increased
R/o Barters n (aka Renin Secreting T) --- BC Urine Chloride levels are High in Barters Syndrome
so now ur left with sureptious vomiting
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| guangyu
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if it is vomiting, why renin going up?
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| cool doctor
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whats the answer Lim?
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| neuroblastoma
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Lim wrote:oh..that's it. i'll post the Q tomorrow. i tried to exract low chrolide from hypokalemic alkalosis. i was wrong. vomitting just make it low chloride. thanks.
sureptious vomiting --low K(2.5) Low Cl.
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| brutus25
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Rule out
1. Hyperaldo and Barter as both go w/ HTN and increased urine chloride
2. Diuretics - because the question tells you so
3. Renin secreting tumor would have HTN
Answer - Vomiting
In vomiting there is :
1 - Every mEq of HCl lost in vomitus is counterbalanced by a mEq gain of HCO3 in blood --> there is accumulation of unneutralized HCO3 in blood
2 - Loss of Cl anions in HCl decreases Cl conc in blood and the amount of Cl anions filtered in urine : random UNa < 20 mEq/L
3 - Excessive vomiting --> volume depletion --> decreases EABV --> might increase renin with subsequent inc in aldo
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| Lim
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sorry for late reply.
It's vomitting.
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| doyoudig
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hey brutus Barters and Gittleman have -- Normal BP
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