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Comments ...

 +1  (nbme22#42)

Step by Step:

  1. NSAIDs block prostaglandins which normally dilate the afferent arteriole
  2. Constriction = decreased blood flow to glomerulus (decreased GFR; decreased RPF)
  3. Decreased blood flow leads to activation of RAAS system
  4. Activation of RAAS leads to increased renin

Why not the other ones:

A. GFR will be decreased due to constriction of the afferent
B. Renal blood flow will be decreased due to vasoconstriciton of the afferent
D & E. Production blocked by NSAID so wouldn't even be around

 +2  (nbme22#21)

Step by step:

  1. pH = low = acidosis
  2. HCO3 = low = acidosis
  3. CO2 = high = acidosis

So, what I've learned is that, in essence, metabolic acidosis always takes priority in these scenarios. It's evident that the person is not compensating, but you want to calculate anyway by using Winter = 1.5 (HCO3) + 8 .
If you calculate you will see that the expected is 30.5.

  1. If CO2 is higher than expected = concomitant respiratory acidosis
  2. If CO2 is lower than expected = concomitant respiratory alkalosis

Here it is higher than expected (65) so concomitant respiratory acidosis.

I guess if you wanted to start with the respiratory acidosis you would've taken into consideration that bicarbonate should've gone up to compensate. It didn't so it's uncompensated. Not sure if there's a formula to calculate the other stuff

Subcomments ...

submitted by seagull(423),

This is a nice approach to identifying and treating factitious disorder.


cinnapie  Not all heros wear capes +  
privwill  Mother of mine strongly believes in this method of treatment... +1