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Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Acid Base Disorders
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Question 6# Print Question

A 62-year-old man with past medical history of benign prostate hyperplasia, congestive heart failure, and hyperlipidemia presents to his primary care physician for a routine follow-up visit. Today, he complains of progressively worsening fatigue and back pain for the past 4 weeks. He states that there are days that he feels so tired that he does not leave the house. He no longer enjoys playing golf or fishing on the weekends. On physical examination, his temperature is 37.2°C, blood pressure is 134/72 mm Hg, pulse rate is 74 beats/min, and respiratory rate is 12 breaths/min. Pallor conjunctiva and point tenderness are noted over his lumbar spine. The rest of the physical examination is unremarkable. His medications include pravastatin, furosemide, and tamsulosin. He also has been taking aspirin daily for his back pain. Laboratory data show the following:

  • Sodium 133 mEq/L (mmol/L)
  • Potassium 3.4 mEq/L (mmol/L)
  • Chloride 104 mEq/L (mmol/L)
  • Bicarbonate 16 mEq/L (mmol/L)
  • Glucose 243 mg/dL
  • BUN 28 mg/dL
  • Creatinine 1.7 mg/dL
  • Albumin 2.9 g/L
  • Calcium 11.3 mg/dL
  • Phosphorous 3.0 mg/dL
  • Total protein 6.2 g/dL
  • WBC 8200/µL
  • Hemoglobin 8.9 g/dL
  • Hematocrit 27.3 g/dL
  • Platelets 250,000/µ


  • pH 7.42
  • pCO2 38 mm Hg

What is the MOST likely cause for the patient’s acid-base disturbance?

A. Starvation ketoacidosis
B. d-lactic acidosis
C. Normal anion gap metabolic acidosis
D. High anion gap metabolic acidosis
E. Dehydration

Question 7# Print Question

A 54-year-old male was brought to the emergency department with nausea and vomiting. He has a long-standing history of alcohol abuse and cardiomyopathy. He complains of severe abdominal pain. On physical examination:

  • his temperature is 37.6°C
  • blood pressure is 94/67 mm Hg
  • pulse rate is 122 beats/min
  • respiratory rate is 20 breaths/min.
  • His BMI is 17

He is tender to palpation over the epigastrium, and guarding is noted. He is kept NPO and treated with aggressive fluid resuscitation. Given his poor respiratory status, he is intubated and admitted to the ICU. After 8 days, he is clinically improving but remains unable to tolerate enteral feeds for which he is started on total parenteral nutrition (TPN) for 5 days.

Laboratory data obtained:

Based on the information provided, what is the BEST explanation for his acid-base abnormalities?

A. Excessive vomiting
B. Administration of normal saline
C. Malnutrition
E. Acute respiratory distress syndrome

Question 8# Print Question

A 72-year-old woman with a past medical history of hypertension, hyperlipidemia, and congestive heart failure (most recent echocardiogram 3 months ago showed an ejection fraction of 45%) is intubated in the ICU for septic shock in the setting of Escherichia coli bacteremia. She received 9 L total of IV fluids, and on examination, she is awake and cooperative, though she has anasarca. She is unable to be weaned off the ventilator due to high respiratory rate, and a chest x-ray obtained shows bilateral vascular congestion. She is given furosemide over the next few days and started on enteral feedings.

After 3 days, repeat laboratory data show the following: 

  • Sodium 146 mEq/L (mmol/L)
  • Potassium 3.2 mEq/L (mmol/L)
  • Chloride 110 mEq/L (mmol/L)
  • Bicarbonate 16 mEq/L (mmol/L)
  • Glucose 143 mg/dL
  • BUN 27 mg/dL
  • Creatinine 1.2 mg/dL
  • Albumin 4.1 g/L
  • Calcium 9.8 mg/dL


  • pH 7.48
  • pCO2 45 mm Hg

Which of the following is MOST likely the cause of her acid-base disturbances?

A. Bartter syndrome
B. Diuretic usage
C. Primary respiratory acidosis
D. Milk-Alkali syndrome
E. RTA type 2

Question 9# Print Question

An 89-year-old man with a past medical history of chronic kidney disease stage III, diabetes mellitus type II, and hypertension who is 4 days status post small bowel resection for a small bowel obstruction. He has a persistent ileus with nasogastric decompression. On the fifth day, he develops palpitations and lethargy. An ECG and laboratory parameters are shown below:

  • Sodium 146 mEq/L (mmol/L)
  • Potassium 3.0 mEq/L (mmol/L)
  • Chloride 90 mEq/L (mmol/L)
  • Bicarbonate 18 mEq/L (mmol/L)
  • Glucose 243 mg/dL
  • BUN 22 mg/dL
  • Creatinine 1.8 mg/dL
  • Albumin 3.7 g/L
  • Lactate 1.0 mmol/L


  • pH 7.28
  • pCO2 28
  • HCO3 33
  • PO2 98%

Based on this, what do you expect his urine pH value to be?

A. 4.1
B. 8.9
C. 6.0
D. 7.4
E. 3.1

Question 10# Print Question

A 23-year-old man is brought to the hospital by his girlfriend. She states that he has not been feeling well, complaining of nausea and abdominal pain for the past 2 days. His younger sister was recently treated for rotavirus, though she denies that anyone else had any other symptoms. Given his lethargy, he has not taken any of his medications. She also admits that he “binge drinks” on occasion but has not consumed any alcohol over 2 months.

On physical examination:

  • his temperature is 36.8°C
  • blood pressure is 92/60 mm Hg
  • pulse rate is 124 beats/min
  • respiratory rate is 10 breaths/min

His oral mucosa is dry, and his pulse is palpable though thready.

Lab results:

  • Sodium 132 mEq/L (mmol/L)
  • Potassium 4.2 mEq/L (mmol/L)
  • Chloride 102 mEq/L (mmol/L)
  • Bicarbonate 10 mEq/L (mmol/L)
  • Glucose 656 mg/dL
  • BUN 42 mg/dL
  • Creatinine 1.4 mg/dL
  • Albumin 4.1 g/L
  • Calcium 9.8 mg/dL


  • pH 7.48
  • pCO2 45 mm Hg

Which of the following is MOST likely the cause of his acid-base disturbances?

A. Starvation ketoacidosis
B. Acute kidney injury
C. Alcoholic ketoacidosis
D. d-Lactic acidosis
E. Diabetic ketoacidosis (DKA)

Category: Critical Care Medicine-Renal, Electrolyte and Acid Base Disorders--->Acid Base Disorders
Page: 2 of 3