Browsing tag

acid-base

THAM

Have you ever given THAM (tromethamine)? For whatever reason I was completely unfamiliar with the drug as a resident, but it is given not infrequently in the surgical ICU’s in the hospitals in which I’ve worked as a…

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Urine Anion Gap

The urine anion gap is calculated as follows:  [urine Na] + [urine K] – [urine Cl].   Think about the urine anion gap much as you think about the serum anion gap.  The urine anion gap is really…

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Gamblegrams

Heard a very good Renal Grand Rounds yesterday from visiting professor Michael Emmett, currently chair of the Dept. of Medicine at Baylor, regarding the anion gap. Amongst the pearls I took away from his lecture: 1.  “Gamblegrams” (left),…

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Toluene & The Kidney

Toluene–a hydrocarbon which is present in gasoline, paint thinners, and many industrial solvents–can have a variety of effects on acid-base metabolism by the kidney:  it can cause both a non-anion gap OR an anion gap metabolic acidosis, depending…

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ENAC Mutations

The ENAC channel in the distal tubule is responsible for sodium reabsorption. It is comprised of 2 alpha, 1 beta, and 1 gamma subunit with each encoded by a separate gene. Interestingly, mutations in ENAC can lead to…

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Unusual Causes of Anion Gap Metabolic Acidosis

The “MUDPALES” acronym, which details the main causes for anion gap metabolic acidosis (Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde, Alcohol, Lactic acidosis, Ethylene glycol, Salicylate toxicity), is one of the most successful medical acronyms of all time. There are…

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