Acid-base and Electrolyte thoughts from Core IM Episode #14

Listening to Episode #14 of Core IM, I imagined discussing this case at VA morning report. For the past 20+ years, each month we have one session in which the chief residents present me acid-base &/or electrolyte cases to dissect. My discussion of this case is different from the podcast. That statement should not surprise anyone. This patient story lends itself to various discussions. I hope this blog post is complementary to the podcast. The presentation of quadriparesis immediately made me consider severe hypokalemia. The patient had no trauma and did not have the classic GB story. Perhaps I lean to severe hypokalemia because I like discussing it.Since the patient did in fact have severe hypokalemia I would stop and discuss a schema for severe hypokalemia. I divide my schema into 3 buckets – decreased bicarbonate normal gap acidosis, normal bicarbonate, and increased bicarbonate metabolic alkalosis. Let’s consider each bucket.Normal gap acidosis – either severe diarrhea (include increased ileal output in patients with ileostomies) or distal RTA. Distal RTA patients often have severe hypokalemia. The most common cause of distal RTA and severe hypokalemia is Sjogren’s syndrome. The additional clues noted in the podcast made this the leading possibility prior to the labs and virtually certain after hearing the labs.Normal bicarbonate – as discussed in the podcast either inherited periodic paralysis or hyperthyroid induced paralysis.Metaboli...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs