More Related Content Similar to Approch to metabolic alkalosis Similar to Approch to metabolic alkalosis (20) 1. Approach to Metabolic Alkalosis DR. ASHRAF ALAWADI Associated Prof. of pediatrics-Alazhar Univ. Head of pediatric department -UDHjEDDAH 13. Investigation U.Na 32 mmol/l U.K 42 mmol/l U.CL 63.2 mmol/lU.Mg 24mg/l U.Phosphorus 242 mg/ l U.Ca 45 mg/l U.Creatinine 116mg/l urinary ca/creatinine ratio 0.387mg/mg Gastrographine study showed mild degree of GERD 20. Vital signs stable . blood pressure Weight 2.85 kg lethargic hypoactive, dehydrated , icteric no signs of respiratory distress Abdomen : soft & lax with positive bowel sounds Rest of examination was unremarkable Physical Examination 21. CBG : pH 7.544, PCO2 37.4 , PO2 45.7, HCO3 31, BE 8.6 CBC : Hb 17.2, Hct 50.3, WBC 8.7, Plt 414, ESR 1, CRP 9 Blood C -ve, BUN 68.3, Cr 1.8, TSB 17.1, RBS 71.3, Na 140.7, K 4.6 Urine Analysis -ve, CXR unremarkable U/S Abd. : distended stomach urine Chloride 4 mmol/L Investigation 22. CT Abdomen and Barium Meal suggestive of bowel malrotation Laparotomy done which diagnosis case as Annular Pancreas and duodenal obstruction release Investigation 38. Metabolic alkalosis with Hypertension Hyperaldosteronism (1ry) Renal artery stenosis Renin secreting tumor Liddle syndrome 11β-HSD deficiency 11β-Hydroxylas deficiency 17α-OH/17,20-lyase deficiency. Licorice abuse 39. what is the significance of urinary chloride? 47. Classification of met. alkalosis A- Chloride responsive metabolic alkalosis (Urine chloride<15Meq/L) Pyloric stenosis Chloride loosing diarrhea Cystic fibrosis GIT fistula/drainage Postdiuretics therapy Vomiting Low chloride intake 48. Classification of met. alkalosis B-Chloride resistant metabolic alkalosis (Urine chloride>20Meq/L) Normotensive Bartter syndrome Gitelman syndrome Hyperprostaglandin E2 severe hypokalemia. Diuretics therapy Alkali loading 50. Renal artery stenosis 51. Renin secreting tumor 54. 11β-Hydroxylase deficiency 55. 17α-OH/17,20-lyase deficiency. 57. DD according to Aldosterone and Renin level ◘ Condition associated with high Aldosterone, high renin Renin secreting tumor Renal artery stenosis Bartter syndrome Gitelman syndrome ◘ Condition associated with high Aldosterone low renin Hyperaldosteronism (1ry) Adrenal carcinoma ◘ 58. ◘ Condition associated with low Aldosterone, low renin Liddle syndrome 17α-OH/17,20-lyase deficiency. 11β-Hydroxylase deficiency. 11β-Hydroxysteroid dehydrogenase (11B-HSD) deficiency.
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