At Renal Grand Rounds last week one of our fellows, Dr. Martina McGrath, presented the case of a 53 year old male with no past medical history, who initially presented with fever, chills, chest pain and epistaxis, was…
Vomiting or nasogastric tube (NG) decompression can lead to metabolic alkalosis, often associated with hypokalemia. When asked what the source of the K loss is, most people assume it is lost in the gastric fluid. However, gastric fluid…
While there are a number of conditions which can cause the combination of hypokalemia and metabolic alkalosis there are a limited number of disease processes which lead to hypokalemia, metabolic alkalosis, AND hypertension. In order to have hypertension…
Metformin is the only hypoglycemic agent proven to reduce mortality in Type 2 DM. As such, we really should be making every effort to prescribe it, and keep patients taking it. Unfortunately, mostly due to it’s relationship to…
Though this is to some degree controversial, volume expansion with normal saline has been associated with the development of a hyperchloremic, non-anion gap metabolic acidosis. What are the mechanisms associated with saline expansion-induced metabolic acidosis? The rationale for…
File “Gordon Syndrome” under “interesting causes of hyperkalemia and metabolic acidosis you may never see.” Also called pseudohypoaldosteronism type II, Gordon Syndrome is relevant less so for the number of patients afflicted but more due to the interesting…
There are some interesting acid-base perturbations that can take place in the setting of eating disorders and/or surreptitious use of substances used to intentionally lose weight. Due to the surreptitious nature of many of these disorders, some lab…
Calcium phosphate stones are actually pretty rare. While calcium oxalate stones comprise about 80% of all instances of nephrolithiasis, calcium phosphate stones typically occur only in a small subset of patients–about 5 to 10% of patients according to…
Pictured on the left is Bob Cratchit and his crippled son, Tiny Tim, two beloved characters from Charles Dickens’ A Christmas Carol. In this fun 1992 article by the pediatrician D.L. Lewis, the case is made that Tiny…
Let’s talk about rapid A.B.G. analysis. Just to clarify, I’m talking about arterial blood gases, not the religious rap group “Adopted By Grace” I just discovered existing by googling the phrase “ABG”. I tend to use Winter’s Formula…
