Lactic Acidosis and Diabetes Mellitus

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Questions and Answers

What is a potential consequence of administering high dosages of propofol?

Starvation ketoacidosis

Diabetic ketoacidosis

Lactic acidosis (correct)

Renal failure

In insulin-dependent diabetes mellitus, what is the primary effect of inadequate insulin?

Decreased glucose absorption

Increased bicarbonate production

Formation of metabolic acidosis (correct)

Enhanced potassium uptake

What characterizes alcoholic ketoacidosis compared to starvation ketoacidosis?

Always presents with low blood glucose

Usually follows excessive vomiting and food deprivation (correct)

Occurs solely due to chronic alcohol use

Is more common in children than in adults

Why does renal failure result in metabolic acidosis?

Inability to excrete acids produced by metabolism Signup and view all the answers

What is a consequence of hyperglycemia in insulin-dependent diabetes mellitus?

Osmotic diuresis Signup and view all the answers

Which symptom is NOT typically associated with salicylate intoxication?

Nausea Signup and view all the answers

What is a primary consequence of ethylene glycol metabolism in the liver?

Formation of glyoxylic and oxalic acids Signup and view all the answers

Which of the following conditions can precipitate metabolic acidosis?

Acute decompensations in inborn errors of metabolism Signup and view all the answers

Which clinical manifestation is commonly observed in children with mild or moderate metabolic acidosis?

Variation in symptoms based on acidemia severity Signup and view all the answers

What is a potential outcome of methanol ingestion?

Damage to the optic nerve Signup and view all the answers

What is a common consequence of ureterosigmoidostomy?

Metabolic acidosis and hypokalemia Signup and view all the answers

What is a sequela of rapid resolution of respiratory alkalosis?

Persistent metabolic acidosis Signup and view all the answers

Which condition can lead to lactic acidosis due to impaired oxygen delivery?

Shock Signup and view all the answers

Which genetic disorder is associated with hyperkalemic renal tubular acidosis?

Gordon Syndrome Signup and view all the answers

What is a potential cause of lactic acidosis in children with short bowel syndrome?

Bacterial overgrowth Signup and view all the answers

Which medication class is known to potentially cause lactic acidosis?

Nucleoside reverse transcriptase inhibitors Signup and view all the answers

What is the typical outcome when the underlying cause of lactic acidosis is addressed?

Correction of metabolic acidosis Signup and view all the answers

What characterizes the metabolic compensation for chronic respiratory alkalosis?

Decreased renal acid excretion Signup and view all the answers

What is the most common presenting complaint in distal renal tubular acidosis?

Failure to thrive due to chronic metabolic acidosis Signup and view all the answers

Which of the following conditions is often associated with proximal renal tubular acidosis?

Fanconi syndrome Signup and view all the answers

In hyperkalemic renal tubular acidosis, which of the following is a common cause?

Inability to respond to aldosterone Signup and view all the answers

What is a characteristic feature of untreated patients with proximal renal tubular acidosis?

Urine pH less than 5.5 Signup and view all the answers

Which feature distinguishes mixed renal tubular acidosis from the other forms?

Caused by mutations in the carbonic anhydrase II gene Signup and view all the answers

What is a potential outcome of chronic hypophosphatemia in children with proximal RTA?

Rickets Signup and view all the answers

What is pseudohypoaldosteronism type I primarily characterized by?

Absence of the sodium channel responding to aldosterone Signup and view all the answers

Which statement about aldosterone deficiency in children is true?

Can lead to isolated hyperkalemia without acidosis Signup and view all the answers

Study Notes

Lactic Acidosis

High doses of propofol and propylene glycol can induce lactic acidosis.
Linezolid is another medication linked to lactic acidosis.
Common causes include inadequate oxygen delivery, shock, anemia, and hypoxemia.
Lactate is produced through anaerobic metabolism; the liver metabolizes it to bicarbonate to correct acidosis.
In severe liver dysfunction, lactate metabolism can be impaired, causing lactic acidosis.
Metabolically active malignancies and short bowel syndrome can lead to lactic acidosis due to inadequate blood supply or bacterial overgrowth.

Insulin-Dependent Diabetes Mellitus

Inadequate insulin can lead to hyperglycemia and diabetic ketoacidosis (DKA).
DKA results in the production of acetoacetic and β-hydroxybutyric acids, contributing to metabolic acidosis.
Insulin administration helps convert keto acids into bicarbonate, aiding in metabolic acidosis correction.
Urinary losses of keto acids can hinder bicarbonate regeneration, requiring renal function for full correction.
Hyperglycemia leads to osmotic diuresis, causing volume depletion and loss of key electrolytes.

Starvation and Alcoholic Ketoacidosis

Starvation leads to a mild metabolic acidosis due to increased kidney acid secretion.
Alcoholic ketoacidosis often follows binge drinking with poor food intake; it can be more severe than starvation-related acidosis.
Blood glucose in alcoholic ketoacidosis can vary, and hypoglycemia may indicate a metabolic disorder.

Renal Failure

Renal failure impairs acid excretion, causing metabolic acidosis.
Remaining nephrons can compensate in mild cases, but significant impairment leads to accumulation of acids.

Hyperkalemic Renal Tubular Acidosis (RTA)

Isolated hyperkalemia is common in transplant recipients; hyponatremia is rare.
Hyperkalemic RTA can arise from conditions like Gordon Syndrome, causing volume expansion and hypertension.

Children with Abnormal Urinary Tracts

Surgical diversions like ureterosigmoidostomy often lead to metabolic acidosis and hypokalemia.
Ileal conduits are preferred, though they still pose a risk for metabolic acidosis.

Metabolic Compensation for Chronic Respiratory Alkalosis

Decreased renal acid excretion and reduced serum bicarbonate occur to counteract respiratory alkalosis.
Following resolution of respiratory alkalosis, residual decreased bicarbonate can lead to metabolic acidosis.

Forms of Renal Tubular Acidosis (RTA)

Distal (Type I), Proximal (Type II), Mixed (Type III), and Hyperkalemic (Type IV) RTA exist, each with distinct features.
Distal RTA presents with hypokalemia and the inability to acidify urine (pH > 5.5).
Proximal RTA is associated with Fanconi syndrome, leading to multiple urinary losses.
Mixed RTA relates to osteopetrosis caused by carbonic anhydrase II mutations.
Hyperkalemic RTA can stem from aldosterone deficiency, leading to various electrolyte imbalances.

Salicylate Intoxication & Metabolic Acidosis

Symptoms include fever, seizures, lethargy, hyperventilation, tinnitus, and coma.
Ethylene glycol metabolizes to oxalic acid, causing severe metabolic acidosis and kidney damage.
Methanol ingestion results in formic acid production, leading to CNS damage, metabolic acidosis, and visual impairment.

Causes and Clinical Manifestations of Metabolic Acidosis

Causes include toluene inhalation, paraldehyde ingestion, and inborn errors of metabolism.
Inborn errors can lead to episodic metabolic acidosis precipitated by specific dietary substrates or stress.
Clinical manifestations depend on the severity of acidemia and may be more pronounced with concomitant respiratory acidosis.
Serum pH changes correlate with the degree of acidemia experienced by patients.

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Description

This quiz delves into the factors contributing to lactic acidosis, including medication effects and metabolic disorders. It also explores insulin-dependent diabetes mellitus and its complications, such as diabetic ketoacidosis. Test your knowledge on these critical topics in metabolic conditions.