ABB/Questions and Case Studies

Questions
{The concentration of hydrogen ions (H+) in body fluids is in the order of: - A – μmol/l + B – nmol/l - C – mmol/l - D – pmol/l
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 * A pH value of 7.40 corresponds to cH+ 40 nmol/l.

{The urinary excretion of H+ in 24 h in an adult is on average around the value: - A – 200 mmol - B – 40 μmol + C – 70 mmol - D – 7 mmol/l
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{The serum buffer bases are given by the values: + A – [HCO3− ] + [Proteinate] - B – [Cl−] + [HCO3− ] + [HPO42− ] + [lactate] - C – [HCO3− ] + [CO32−]
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 * The serum buffer bases (BB) are given by the sum of the values of bicarbonate (24 mmol/l) and proteinate anion (18 mmol/l) and are therefore normally 42 mmol/l.

{Recognition of metabolic acidosis (MAC) in mixed ABR disorder allows: + A – finding of elevated "anion gap" values + B – decrease in pO2 in arterial or central venous blood + C – low haemoglobin in the blood + D – increased blood lactate
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{Significant hypoproteinemia with a decrease in residual anions leads to: + A – MAL - B – MAC - C – RAL + MAC - D – MAC + RAC
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 * Reduction of protein together with a reduction of residual anions leads to an expansion of the "bicarbonate space" and thus to metabolic alkalosis

Patient with scoliosis and cardiac defect
A 17-year-old patient admitted to the hospital with congestive heart defect and scoliosis. Laboratory investigated on admission and again 24 h later.

Urine:


 * Proteins 1 g
 * pH = 6
 * 3-6 hyaline cylinders
 * other findings normal


 * 1) What was the  ABB disorder on admission?
 * 2) What was the  ABB impairment after 24 h?
 * 3) What was the cause of the decrease in serum K+ over 24 h?
 * 4) Does the clinical status correspond to the laboratory findings?

Patient in acute respiratory distress
A 51-year-old man admitted to hospital with acute respiratory distress syndrome (ARDS). The patient smokes 3 packs of cigarettes a day.


 * 1) How do you rate ABB at the time of patient admission?
 * 2) Is the oxyhemoglobin dissociation curve shifted?
 * 3) What is the significance of the other results?

Patient in diabetic coma
A 15-year-old girl is brought to the E.R. in a coma. She's been diabetic for 7 years, taking insulin. She's had several bouts of hypoglycemia and ketoacidosis. She has had a lot of studying at school recently and may have neglected some insulin injections.


 * 1) What is the diagnosis?
 * 2) Calculate the anion gap (AG), what is the cause of the high AG?
 * 3) What is the significance of the increased osmolality?
 * 4) Why are chloride and HCO3- decreased, what is the significance of "normal" Na+ and increased K+?

Patient with pulmonary insufficiency and hypokalemia
Patient 55 years old, with chronic obstructive pulmonary disease, who was treated for a long time with thiazide preparations (as a diuretic).

Laboratory results on admission


 * 1) What is the fault in ABB?

Related Article

 * ABB
 * Disorders of acid-base balance
 * Diabetic ketoacidosis
 * Oxygen transport through the blood