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M U D P I L E S

M U D P I L E S. Methanol/Ethylene glycol visual sx Ca oxalate xtals Woods lamp Osm gap. M U D P I L E S. Uremia BUN/Creat DKA Paraldahyde pungent odor Isoniazid hx TB Rx. M U D P I L E S. Lactic Acidosis Abd pain -> dead gut Decreased perfusion Liver failure Alcohols

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M U D P I L E S

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  1. M U D P I L E S • Methanol/Ethylene glycol • visual sx • Ca oxalate xtals • Woods lamp • Osm gap

  2. M U D PI L E S • Uremia • BUN/Creat • DKA • Paraldahyde • pungent odor • Isoniazid • hx TB Rx

  3. M U D PIL E S • Lactic Acidosis • Abd pain -> dead gut • Decreased perfusion • Liver failure • Alcohols • Meds • Inborn errors • Lactate -> 27

  4. M U D PILE S • Ethanol - Alcohol Ketoacidosis • Binge drinker, Not eating • Salicylates • Hx of ASA use

  5. Alcohol ketoacidosis • Uncommon, often missed • Binge drinkers

  6. AKA - 3 factors • Alcohol intake • Decreased caloric intake • Volume depletion Results in starvation physiology

  7. AKA • Decreased caloric intake • Counter regulatory hormone release • Epinephrine, cortisol, growth hormone • Elevated glucagon, decreased insulin • Promotes lipolysis and fatty acid mobilization • Volume depletion • Elevated glucagon, decreased insulin

  8. AKA • Alcohol intake • Oxidation of ETOH-> ->acetate • NAD->NADH which raises glucagon, decreases insulin • Promotes betahydoxybutyrate vs acetoacetate • Decreased gluconeogenisis

  9. AKA • Symptoms • N, V, abd pain • Dyspnea, tremulousness • Muscle pain, fever, diarrhea, syncope, Sz • Physical • Tacycardia, tachypnea, abdominal pain, • Hepatomegaly, hypotension

  10. AKA • Differential Dx • Cholecystitis • Peptic ulcer, gastritis • Mesenteric ischemia • Pacreatitis • Withdrawal syndromes • Metabolic acidosis • DKA • Methanol, Ethylene glycol

  11. AKA - labs • pH –low, high or nl • Metabolic acidosis -> ketones • Metabolic alkalosis -> vomiting • Respiratory alkalosis -> hyperventilation • Serum ketones low, high or nl • Betahydoxybutyrate • Lytes –abnormal • Lactate – mildly elevated

  12. AKA-treatment • Volume replace • Carbohydrate replacement • D5NS • Fix electrolyte abnormalities • K, Mg, acidosis • Address associated problems • Withdrawal, Wernikes, GI bleed, hepatitis, pancreatitis, pneumonia, rhabdo, etc.

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