A patient of CKD has presented with protracted vomiting. ABG shows pH = 7.40, pCO2 = 40 mm Hg, HCO3 = 25 mEq, Na=145 mEq/L, Chloride = 100 mEq/L, HCO3 = 24 mEq/L. What is the observation?
(A) Normal anion gap metabolic acidosis (B) High anion gap metabolic acidosis (C) No acid base abnormality (D) High anion gap metabolic acidosis and metabolic alkalosis
(D) AG(Anion Gap)= Na+ - (Cl- + HCO3-) = 145-124 = 21 meq Normal 8-10meq Rules out option a. - CKD is condition where patient experiences impaired ability to excrete H+ - Vomiting contributes to metabolic alkalosis - Two processes simultaneously occurring So answer is High anion gap metabolic acidosis and metabolic alkalosis.