A patient who is a known case of CKD has complaints of vomiting. His ABG repos are as follows: pH - 7.40, pCO2 - 40, HCO3 - 25. Na -145, chloride-100.
(A) Normal anion gap met acidosis (B) High anion gap met acidosis (C) No acid base abnormality (D) High anion gap metabolic acidosis with metabolic alkalosis
(D) Ans. D. High anion gap metabolic acidosis with metabolic alkalosis Even though ABG looks completely normal - clinical history is the key here.CKD patients generally have high AG metabolic acidosis. On the background of that he has developed vomiting (which is an alkalotic state). Both opposing disorders have normalized the ABG. But the patient is actually having a double disorder.