Category Archives: Nephrology

Hypocomplementemia: Key Points and Mnemonics

You don’t need to memorize which glomerulonephritides are associate with low complement and which are not. Rather, ask yourself one question: does this patient have persistent, aggressive, endovascular, systemic infectious or inflammatory processes? If the answer is “yes,” then the disease is associate with low complement levels. If the answer is “no,” then complement level will be normal.… Read More »

How to Solve Triple Acid-Base Problems Quickly in Your Head

Introduction You can solve triple acid-base problems with basic arithmetic and straightforward logic. As an example, let’s work through the following rather classic triple acid-base problem: An afebrile, atraumatic 26-year-old male with no past medical history is brought to the emergency department because of a three hour history of altered mental status, vomiting and vertigo. The physical examination is positive only for somnolence… Read More »

How to Spot a Falsely Normal Anion Gap

Introduction A high anion gap metabolic acidosis can be a very dangerous acid-base abnormality. The “gap” itself is just a number – it isn’t harmful per se. Rather, the danger is from the acidosis and from the process that is generating the abnormal and excessive organic acid load. The most common screening test for high anion gap metabolic acidosis is… Read More »

Hypermineralocorticoidism Explained

Introduction Aldosterone is the most important mineralocorticoid in the human body, although various other hormones, such as cortisol, display mineralocorticoid activity as well, namely they cause hypertension, hypokalemia, and chloride resistant metabolic alkalosis (urine chloride > 20). In addition, mineralocorticoids can also cause hypernatremia and hypervolemia. The triad of hypertension, and hypokalemia and chloride resistant metabolic alkalosis should make one think… Read More »

Acid-Base Abnormalities and Their Causes

Introduction Acid-Base pathophysiology plays an important role in every aspect of medical practice, including psychiatry. Doctors and medical students need to know, both for real life and for examinations, the predicted acid base disorder of various diseases. It is much easier to interpret ABGs when you know ahead of time what to expect: So let’s start with the metabolic… Read More »

Book Review: Acid-Base Case Studies, 2e

I’ve been looking at Acid-Base Case Studies (2004) by Ira Kurtz MD for a long time now, at least since I’ve written several months ago, wrongly, that a solid book with a case-based approach to acid-base disorders does not exist. It does in fact exist, and this is it. The book presents the reader with dozens of  clinical scenarios and dissects… Read More »