"Injecting somebody with potassium is what they do to death row criminals when they execute them." Brilliant. I will forever remember to get an EKG with elevated K levels because of this sentence. Thank you!!
I an confused about question 13. The patient definitely has Metabolic Acidosis BUT when calculating her pCO2 for expected compensation, you get a range of 34.5 - 38.5... her measured pCO2 is LOWer than is should be so doesn't she have a respiratory alkalosis as well => Non-AG Metabolic Acidosis with Respiratory Alkalosis?
Yes its Non anion gap metabolic acidosis with respiratory alkalosis Since compensation of PCO2 doesn't match with HCO3 according to winters formula..there is additional respiratory alkalosis.
www.ncbi.nlm.nih.gov/pmc/articles/PMC5782483/ Seems to be rare but indeed possible. Gotta admit I was also in the "WTF" mode when I saw this answer - not even Katzung mentions this SE.
Livvy Liv - Nephrologist I worked under liked to use Norvasc in black patients. I'm not sure how much evidence is behind that but I trust this particular nephrologist.
That's true but ACEi/ARBs are nephro-protective in diabetics, including Africans and Caribbeans. CCBs are not. That should take priority. In real life (outside of board exams) you can start both. For example, there are amlodipine- losartan (Cozaar brand) and amlodipine-benazepril (Lotrel brand) combination pills.
Great job Dr Bolin but in question 12, you have not calculated using the Winter's formula hence you cannot guess if the pCO2 is appropriately low. The picture looks more like Metabolic acidosis and Respiratory alkalosis
Verapamil/Diltiazem not good for hypertension as they cause less vasodil and more bradycardia and good choices for Afib or SVT - if you wana use calcium channel blocker use Didhydropyridine calcium channel blockers like Felodipine . Usually the 2nd drug to add for blood pressure control is a thiazide diuretic for normal GFR and for stage 3-4 CKD a loop diuretic .
Why not treat first with insulin and calcium gluconate to drive the potassium into the intracellular space and then carry out haemodialysis. Hyperkalemia increases cardiac excitability and therefore predisposes to arrhythmias.
Low bicarb is acidosis Low CO 2 is Resp alkalosis which is compensating And therefore the pH is normal. If its met acidosis, pH should be way below 7.374, and chloride would be high and bicarbonate would be conserved.
Nephrology: And Pathology thereof.....Outstanding Narration and Examination (Simulation). MD Paul Bolin, es geht gut zu lernen und Spass machen. Prost!
34:55 Question 10 - According to your other video Goodpasture would present with microhematuria; in the presented case the patient notices blood in the urine. Great review!
Thank you so much dr. But I am not clear with the answer for Q5. as for my understanding we first check the PH if acidic or alkaline, then we go which go with that, that is if HCO3, we say metabolic, and Pco2, respiratory and the one opposite to PH is called compensatory. Can you comment? thank you.
In 2 quetion that ABG with similar number One you said metabolic acidosis with Respiratory alkalosis However another one just metabolic acidosis because you said PH is not normal While the previous one PH WASNOT normal too.
"Injecting somebody with potassium is what they do to death row criminals when they execute them."
Brilliant. I will forever remember to get an EKG with elevated K levels because of this sentence. Thank you!!
I love these CRASH Reviews. I just wish the slides would keep up with you talking! You give the answer before I even get a chance to see the slide.
Thank you so much Dr.Bolin! it was very very useful!
I an confused about question 13. The patient definitely has Metabolic Acidosis BUT when calculating her pCO2 for expected compensation, you get a range of 34.5 - 38.5... her measured pCO2 is LOWer than is should be so doesn't she have a respiratory alkalosis as well => Non-AG Metabolic Acidosis with Respiratory Alkalosis?
correct sir...its a wrong answer to give just simply metabolic acidosis
Yes its Non anion gap metabolic acidosis with respiratory alkalosis Since compensation of PCO2 doesn't match with HCO3 according to winters formula..there is additional respiratory alkalosis.
Great as always. sir paul bolin...
Great lecture..professional person ..
Lisinopril.For reno protection and cardio protection. Salt restriction must have been tried since the past 2 months or earlier.
love your work man
I couldn't find anything on my notes saying that NSAIDs causes rhabdomyolysis. UptoDate is not helping either. Do you have a source for that?
www.ncbi.nlm.nih.gov/pmc/articles/PMC5782483/
Seems to be rare but indeed possible. Gotta admit I was also in the "WTF" mode when I saw this answer - not even Katzung mentions this SE.
Yes me too
JNC 8 guidelines suggest AA without proteinuria first line is either a thiazide diuretic or calcium channel blocker.
Would you give a thiazide or ARB to a black patient without DM?
Livvy Liv - Nephrologist I worked under liked to use Norvasc in black patients. I'm not sure how much evidence is behind that but I trust this particular nephrologist.
Paul Bolin, M.D. Thanks for your reply as usual, Dr. Bolin.
In question 9, aren't afrocarribean people meant to be started on a Ca channel blocker not an ARi/ARB?
That's true but ACEi/ARBs are nephro-protective in diabetics, including Africans and Caribbeans. CCBs are not. That should take priority. In real life (outside of board exams) you can start both. For example, there are amlodipine- losartan (Cozaar brand) and amlodipine-benazepril (Lotrel brand) combination pills.
Great job Dr Bolin but in question 12, you have not calculated using the Winter's formula hence you cannot guess if the pCO2 is appropriately low. The picture looks more like Metabolic acidosis and Respiratory alkalosis
Met acidosis with compensatory Resp alkalosis
Hi regarding Question 9 why is hydrochlorothiazide used instead of verapamil?
Verapamil/Diltiazem not good for hypertension as they cause less vasodil and more bradycardia and good choices for Afib or SVT - if you wana use calcium channel blocker use Didhydropyridine calcium channel blockers like Felodipine . Usually the 2nd drug to add for blood pressure control is a thiazide diuretic for normal GFR and for stage 3-4 CKD a loop diuretic .
In short these two verapamil and diltiazem work to reduce heart rate different from other ca channel blockers.
Question 13 , is similar with question 5, why not mixed disorder? Using winter calculation
You are right!
Wow man. Amazing!
Diastolic unchanged. It could be a normal ejection fraction diastolic failure.
Why not treat first with insulin and calcium gluconate to drive the potassium into the intracellular space and then carry out haemodialysis. Hyperkalemia increases cardiac excitability and therefore predisposes to arrhythmias.
Low bicarb is acidosis
Low CO 2 is Resp alkalosis which is compensating
And therefore the pH is normal.
If its met acidosis, pH should be way below 7.374, and chloride would be high and bicarbonate would be conserved.
Ammonium phosphate stone. Or some metabolic error.Lesch Nyhann, struvite, triple phosphate stag horn, hyoercalcemia
big picture is metabolic acidosis so PCO2 should be say 33 but it is much lower so patient has additional respiratory alkalosis
Good pasteur.
Thank you soo much Dr.
I really want to know how can i download these videos as slides. (power point)
thank you again.
wish you all best.
Nephrology: And Pathology thereof.....Outstanding Narration and Examination (Simulation). MD Paul Bolin, es geht gut zu lernen und Spass machen. Prost!
Ideally an Echo. Otherwise EKG. To rule out cardiac abnormalities.
34:55 Question 10 - According to your other video Goodpasture would present with microhematuria; in the presented case the patient notices blood in the urine.
Great review!
Haemodialysis. Creatinine is 7.7.Anemia is due to renal failure.
Amazing
If we apply winter's formula in question 13 then answer becomes 'metabolic acidosis with respiratory alkalosis.plz can you explain sir?
Your question 13 is being narrated while still displaying the answer of 12 th question. I think recording has to be rectified.
Regarding #9, according to JNC 8 wouldn't you give a CCB or thizide as 1st line for blacks?
Why waste money on CT first if USG can be done.
Metabolic acidosis.But why is the PCO2 low.
Ketorolac to relieve pain.
Thank you so much dr. But I am not clear with the answer for Q5. as for my understanding we first check the PH if acidic or alkaline, then we go which go with that, that is if HCO3, we say metabolic, and Pco2, respiratory and the one opposite to PH is called compensatory. Can you comment? thank you.
Nephro pains are colicky not constant.
In 2 quetion that ABG with similar number
One you said metabolic acidosis with Respiratory alkalosis
However another one just metabolic acidosis because you said PH is not normal
While the previous one PH WASNOT normal too.
I think the answer for number 13 is E.
KUB or US
B. This is nephrotic range.
Type 1 RTA
Diuretics and Fludrocortisone is for type 4 RTA
Poor blacks! Valsartan is very expensive.
Pelvicalyceal stone. Stag horn.
2020
A
Medullary sponge disease.
B
Cystinuria
bioxcell reviews
Diastolic on the rise.