Acid-Base Disorders

A 58-year-old man with chronic kidney disease stage 4 (eGFR 22 mL/min/1.73m²) presents with metabolic acidosis (pH 7.28, HCO₃⁻ 16 mEq/L, normal anion gap). He is asymptomatic and has no contraindications to alkali therapy. What is the drug of choice for management of his metabolic acidosis?

In respiratory acidosis, what is the primary mechanism by which the kidneys compensate?

A 32-year-old woman with newly diagnosed systemic lupus erythematosus presents with dyspnea and chest pain. Arterial blood gas shows pH 7.48, PaCO₂ 28 mmHg, HCO₃⁻ 21 mEq/L, and PaO₂ 65 mmHg on room air. Which investigation is most appropriate to confirm the underlying acid-base disorder and identify its etiology?

A 28-year-old woman from Delhi presents with a 3-day history of severe vomiting following food poisoning. On examination, she is alert but appears dehydrated. Vital signs: BP 100/62 mmHg, HR 110/min, RR 18/min. Laboratory findings: pH 7.52, PaCO₂ 48 mmHg, HCO₃⁻ 38 mEq/L, Na⁺ 138 mEq/L, K⁺ 2.8 mEq/L, Cl⁻ 92 mEq/L. What is the primary acid-base disturbance?

A 52-year-old man with chronic kidney disease (eGFR 18 mL/min/1.73 m²) presents with dyspnea and confusion. He reports poor appetite and nausea for 2 weeks. Vital signs: RR 28/min, BP 145/92 mmHg. Arterial blood gas: pH 7.28, PaCO₂ 32 mmHg, HCO₃⁻ 14 mEq/L, anion gap 18 mEq/L. Serum creatinine 4.2 mg/dL, K⁺ 6.1 mEq/L. What is the acid-base diagnosis?