The most appropriate therapy for this patient would

Discussion in 'MRCS Forum' started by Lona., Oct 25, 2007.

  1. Lona.

    Lona. Guest

    The most appropriate therapy for this patient would be -
    a- Infusion of 0.9% NaCL with supplemental KCI until clinical signs of volume depletion are eliminated
    b- Infusion of isotonic (0.15 N) HCI via a central catheter
    c- Clamping the nasogastric tube to prevent further acid losses
    d- Administration of Acetazolamide to promote renal excretion of bicarbonate
    e- Intubation and controlled hypoventilation on a volume-cycled ventilator to further increase Pco2
  2. Lona.

    Lona. Guest

    Answer: a- Infusion of 0.9% NaCL with supplemental KCI until clinical signs of volume depletion are eliminated. (Greenfield, 2/e, pp 259-266) The development of a clinically significant metabolic alkalosis requires not only the loss of acid or addition of alkali, but renal response that maintain the alkalosis. The normal kidney can tremendously augment its excretion of acid or alkali in response to change s in ingested load. However, in the presence of significant volume depletion and consequent excessive salt and water retention, the tubular maximum for bicarbonate reabsorption is increased. Correction of volume depletion alone is usually sufficient to correct the alkalosis, since the kidney will then excrete the excess bicarbonate. HCI infusion is usually unnecessary and can be dangerous. Acetazolamide is unlikely to be effective in the face of distal Na+ reabsorption (in exchange for H+ secretion). Moreover, to the extent that Acetazolamide causes natriuresis, it will exacerbate the volume depletion.

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