The Curbsiders Internal Medicine Podcast | MedEd | FOAMed | Internist | Hospitalist | Primary Care | Family Medicine
#88: Acid base, boy bands, and grandfather clocks with Joel Topf MD
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Manage episode 201765179 series 1345893
Dominate acid-base disturbances with the wisdom of @kidney_boy aka Joel Topf, MD, Chief of Nephrology at Kashlak Memorial Hospital. Master his 5 key steps for interpreting acid-base disorders and decode any ABG, VBG, and BMP to find the primary disorder, and any other disorders tucked away in the ABG! Plus: Henderson-Hasselbach and pH simplified; the anion gap, should your correct it?; choice of IV fluid; osmolar gaps, methanol, ethylene glycol, isopropyl alcohol; and how metabolic disorders are like a boy band. Be sure to follow along the Dr. Topf’s brilliant acid-base powerpoint.
Written and produced by Joel Topf MD, Shreya Trivedi MD, Xavi Jimenez MD; Images by Hannah Abrams; Edited by Matthew Watto MD
Full show notes available at http://thecurbsiders.com/podcast
- 00:00 Announcement
- 01:00 Disclaimer
- 01:34 Intro
- 02:45 The setup and guest bio
- 03:15 How does Dr Topf compensate for difficulty
- 07:10 What has helped Dr Topf become successful as an educator
- 10:40 With which electrolyte do you most closely identify?
- 14:05 Picks of the week
- 16:05 Nephmadness explained
- 19:50 Joel’s big picture look at acid base
- 22:17 Acid base and logorhythmic scale
- 24:28 A caution about ABGs
- 27:23 Clinical case from Kashlak Memorial Hospital
- 28:05 Misinterpretation of low bicarb on a metabolic panel
- 29:20 Step 1 of acid base
- 32:00 Metabolic disorders and One Direction
- 35:15 Acidemia vs acidosis; alkalemia vs alkalosis
- 37:52 Compensation for acid base disorders
- 40:45 ABG apps and analyzers
- 42:40 Step 2 Is there a second primary disorder? Use equations for determining if compensation is appropriate.
- 51:31 How to determine if respiratory compensation is acute or chronic
- 54:26 Step 3 The anion gap
- 57:21 Correcting the anion gap
- 60:33 What causes a low anion gap?
- 63:58 Anion gap acidosis
- 66:05 GOLDMARK
- 69:15 Step 4 Is there an osmolar gap?
- 71:48 Toxic ingestions: Methanol, ethylene glycol, and isopropyl alcohol
- 76:15 Calculating the osmolar gap
- 79:08 Step 5 Gap-gap calculation aka “the bicarbonate before”
- 85:05 Choice of IV crystalloid fluid and when to use a bicarbonate drip
- 88:15 Bicarbonate in DKA
- 90:18 NephMadness plug
- 91:10 Outro
Tags: acid, base, anion gap, metabolic, respiratory, toxic alcohol, goldmark, mudpiles, albumin, acidosis, alkalosis, compensation, nephrology, Henderson-Hasselbalch, equation, ABG, VBG, bicarbonate, pCO2, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
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