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Anion gap metabolic acidosis and hypokalemia
2%
1/54
Metabolic alkalosis and hyperkalemia
9%
5/54
Metabolic alkalosis and hypokalemia
20%
11/54
Non-anion gap metabolic acidosis and hypokalemia
Respiratory acidosis and hyperkalemia
57%
31/54
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This patient is experiencing severe vomiting likely secondary to food poisoning. He would likely have hypokalemia and a metabolic alkalosis secondary to activation of the renin-angiotensin-aldosterone system (RAA) and HCl loss in his vomit. Vomiting can cause dehydration and electrolyte abnormalities. When patients vomit, they lose both chloride and acid equivalents. For this reason, vomiting over long periods of time can lead to metabolic alkalosis and hypochloremia. Additionally, patients with vomiting are typically dehydrated which stimulates the renin-angiotensin-aldosterone system which subsequently causes retention of sodium, chloride, and water. Activation of the RAA system also leads to the loss of potassium secondary to aldosterone's activity on the principal cells and loss of hydrogen ions secondary to its action on the intercalated cells. No specific treatment is needed for these patients other than fluids and electrolyte replacement. Incorrect Answers Answer 1: Anion gap metabolic acidosis and hypokalemia would be seen in diabetic ketoacidosis. Patients will experience an anion gap acidosis from fatty acid breakdown (from insulin deficiency), hyperventilation (lowering the PCO2 to correct the pH), and hypokalemia late in presentation as total body potassium stores continue to deplete. Answer 2: Metabolic alkalosis and hyperkalemia are incorrect as aldosterone causes potassium secretion from the principal cells leading to hypokalemia. Answer 4: Non-anion gap metabolic acidosis and hypokalemia are incorrect as increased aldosterone activity leads to H+ wasting from the intercalated cells causing metabolic alkalosis. Answer 5: Respiratory acidosis and hyperkalemia are incorrect as this patient's HCl loss in his vomit will induce a metabolic alkalosis which will lead to respiratory compensation to correct the acid-base disturbance (in the form of an elevated PCO2); however, aldosterone's action on the principal cells leads to potassium loss in the urine causing hypokalemia. Bullet Summary: Vomiting leads to HCl loss and activation of the renin-angiotensin-aldosterone system which can cause metabolic alkalosis and hypokalemia.
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