ngaybinhyen wrote:
This is a tricky Q to me. While I agree with you about HCl loss from vomitting, the child is in shock and could produce acid from his hypoperfusion. Moreover, Cl loss is not the direct reason for acidemia. I don't know if we should pick A up. There are 2 reasons for this acidemia status 1) loss from GI system, 2) hypoperfusion
please comment
-t.
Yeah, maybe A by exclusion, but "excessive metabolic acid production"---What does that mean?
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| ngaybinhyen
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lactic acidosis due to hypoperfusion. this might make some sense to me, dont you think?
please comment
-t.
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| Oussama77
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Acid and base problems
Clinicians may observe derangements of acid-base balance with volume depletion. Some degree of metabolic acidosis is common, especially in infants.
Mechanisms include bicarbonate loss in stool and ketone production. Hypovolemia causes decreased tissue perfusion and increased lactic acid production. Decreased renal perfusion causes decreased glomerular filtration rate, which in turn leads to decreased hydrogen (H+) ion excretion. These factors combine to produce a metabolic acidosis.
In most patients, acidosis is mild and easily corrected with volume restoration (as increased renal perfusion permits excretion of excess H+ ions in the urine). Administration of glucose-containing fluids further decreases ketone production.
http://www.emedicine.com/emerg/TOPIC372.HTM
What o u think friends?
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| ngaybinhyen
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I ... totally agree, friend.
-t.
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