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NBME 20 Answers

nbme20/Block 4/Question#31 (41.3 difficulty score)
A 48-year-old man is brought to the emergency ...
Cl-: 96 mEq/L; HCO3-: 8 mEq/LπŸ”

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submitted by hayayah(1056),
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meningitis  I found this to add a little bit more explanation as to how it causes the acidosis if anyone needs it. 1. Mitochondrial toxicity - decreases aerobic respiration and shunts to lactic acid production 2. Cardio toxicity (Secondary to Mitochondrial toxicity) leads to cardiogenic shock (hypoperfusion), which causes lactic acidosis 3. Hepatotoxicity - Decreases lactate metabolism, causing lactic acidosis 4. When in trivalent form (Fe+3), it can react with 3 molecules of H2O --> FeOH3 + 3H+ This will then deplete Bicarb buffering system resulting in non-gap acidosis. Source: +17  
sympathetikey  None of the other choices were even metabolic acidosis. They threw us a bone with this one. +21  
imnotarobotbut  Don't changes in bicarb take a few days? How did his bicarb drop down to 8 in 12 hours? +2  
charcot_bouchard  its met acidsis. not compensation +7  
j44n  they did throw us a bone however I didnt catch it +1  

submitted by markmizrachi(0),

High anion gap metabolic acidosis due to Iron excess (the I in MUDPILES). Serum anion gap = (Na) - [(HCO3 + Cl)]. Chloride levels low;HCO3 low, which results in the high anion gap.