intern_doc
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1. What kind of acid base disturbance do you find in kid and adult ?
a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis
e. mixed
2. Pt walk in present with a nasal polyps. You ask the pt for current medication. He said he ONLY take Aspirin. What will he likely develop later on ?
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| Idiopathic
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In an Aspirin overdose, it will be mixed, due to aspirin stimulation of the breathing center.
Triad asthma = asthma, nasal polyps, aspirin use.
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| rida
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Are you sure its a mixed acidosis, because i thought aspirin poisoning only results in metabolic poisoning and increase in anion gap???
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| dxtxpx
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A severe metabolic (ketolactic) acidosis with compensatory respiratory alkalosis may develop with severe salicylate intoxication. A paradoxical aciduria (hydrogen ion excretion) occurs with the depletion of sodium bicarbonate and potassium.
http://www.emedicine.com/emerg/topic514.htm
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| Idiopathic
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For Step 1 purposes, a mixed disorder occurs. Salicylate toxicity causes a metabolic acidosis and a respiratory alkalosis...one of the few examples where pH will be normal with offsetting metabolic/respiratory disturbances.
NOTE: this does not happen in young children. They get pure metabolic acidosis.
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| intern_doc
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Correct Idiopathic....
kid=> metabolic acidosis
adult=> mixed (btw...USMLE HY)
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| mmoghbelli
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Why not children?
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| mash
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in chldren , resp alkalosis do occur but it passes of v quickly so they present with met acidosis only....
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| Idiopathic
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I have been told that aspirin does not stimulate the breathing center as much in children (remember this is NOT compensation, but a mixed disorder).
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| mash
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yeah absolutely, it is not a compensatory mech . resp alkalosis is due to direct stimulation of resp center
in kids, it does not stimulate resp center dat much so, they ve a transient phase of resp alkalosis
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| drdk76
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i feel there is a difference in the type of acid base disturbance i.e its dose dependent--in high therapeutic doses --there is respiratory alkalosis(stimulation of respiratory center) but toxic doses cause mixed metabolic & respiratory acidosis(inhibits resp. center)- which means toxic doses cause a mixed acidosis state
in children --respiratory alkalosis is not very common coz the toxic dose for them is low- am i correct? please clarify....
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| JAS
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Dose-dependant actions
High therapeutic: mild uncoupling of oxidative phosphorylation leads to ↑ respiration→↓ Pco2 →respiratory alkalosis →renal compensation → ↑ HCO-3 ELIMINATION → compenstated respiratory alkalosis (PH =normal, ↓ HCO-3 ↓Pco2 ).
In adults, this can be a stable condition; in children → ↑ toxicity.
Toxic doses: inhibit respiratory center →↓ respiration → ↑ Pco2→ Respiratory acidosis plus inhibition of Krebs cycle and severe uncoupling of oxidative phosphorylation → metabolic acidosis, hyperthermia and hypokalemia.
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| JAS
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Dose-dependant actions
High therapeutic: mild uncoupling of oxidative phosphorylation leads to ↑ respiration→↓ Pco2 →respiratory alkalosis →renal compensation → ↑ HCO-3 ELIMINATION → compenstated respiratory alkalosis (PH =normal, ↓ HCO-3 ↓Pco2 ).
In adults, this can be a stable condition; in children → ↑ toxicity.
Toxic doses: inhibit respiratory center →↓ respiration → ↑ Pco2→ Respiratory acidosis plus inhibition of Krebs cycle and severe uncoupling of oxidative phosphorylation → metabolic acidosis, hyperthermia and hypokalemia. :P :shock:
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| styne
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1.Can Misoprostol , prostaglandin type 1 reverse or control asthma triad
due to its beneficial effect on stomach lining.
2.Are chronic nasal polyposis a result of acid base disturbance in ASA patients?
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