A Patient Presenting With Metabolic Acidosis Despite Severe Vomiting--correctdiagnosis By Use Of The Physical-chemical Approach.
1. Am J Emerg Med. 2013 Jun;31(6):995.e1-2. doi: 10.1016/j.ajem.2013.01.022. Epub2013 Mar 7. A patient presenting with metabolic acidosis despite severe vomiting--correctdiagnosis by use of the physical-chemical approach. Lindner G(1), Pfortmller C, Exadaktylos AK. (1)Department of Internal Medicine, Inselspital, University Hospital Bern, Switzerland. [email protected] Erratum in Am J Emerg Med. 2013 Oct;31(10):1535. We describe the case of a 28-year-old otherwise healthy woman who presents to ouremergency department with nausea for 2 days and severe vomiting for 1 day. Shehas no history of travel, and her medical history is unremarkable. The physicalexamination shows a soft and nontender abdomen. Laboratory examinations revealthe presence of significant metabolic alkalosis despite the severe vomiting ofthe patient. Hypochloremic alkalosis would be expected to be present in thispatient. We explain how to correctly identify the rare cause of metabolicacidosis present in this patient using the physicochemical approach (Stewartsapproach) for the analysis of human acid-base disorders. Continue reading >>