thank you very much , as an internal medicine resident in a third world country these lectures will definitely improve my ability to take care of my patients
Hello! Let me start by thanking you for your videos. The content and the way that you present it remarkable!! I´d like to argue if in the last case discussed in this video (pregnant 32 year old with 4 days of vomiting), the elevated anion gap acidosis could be due to multiple causes, like acute serious renal failure (for a pregnant woman those BUN and Cr values are too high for comfort), plus the one that you mencioned, elevated lactate due to shock, plus ketoacidosis due to fasting.
Thank you so much Sir for your videos. Presentation is very appealing, and your knowledge is inspiring. During these trying times, it helps me prepare for managing the covid crisis. And please take care.
very nicely explained and great use of presentation skills to help reinforce key concepts. awesome video! I can see that these videos are a result of a lot of hard work and great teaching skills :D
In example 2 you said we will require her Urine pH among other investigations. Can you explain the significance of Urine pH in this case and how we can use that value to reach a diagnosis
Thanks for these excellent Lectures Dr Strong! Some intensivists advocate using hypothetical normal values to interpret ABGs some of which you have also mention - HCO3 - 24 but in addition to that pH - 7.4 so that > 7.4 as in ex 3 - alkalemia and vice versa and pCO2 of 40 as normal. Using these 3 "normal" values - my conclusions have been the same so far except for ex 3 where that would have generated a diagnosis of primary metabolic alkalosis and secondary respiratory acidosis (as opposed to the AGMA indicated)...just wanted to hear your perspective on this as it seems to have worked in most acid-base disorders that I have encountered so far with my little experience?
Do you have any reference document about complex acid-base disorders in which the overall pH is normal, I found this problem has a little bit difficult to use for clinical?
Hi Dr. Eric. Regarding the last example, here's a pregnant woman with PaCO2 of 42. Normally you would expect respiratory alkalosis in pregnancy (physiologically) . So could the diagnosis infact be high anion gap metabolic acidosis plus respiratory acidosis plus metabolic alkalosis ?
Hello,Mr Eric I was wondering in setting of patient like the example3 which has normal ph wide anion gap, but what if delta hco3=0 delta ratio would be infinity ,what could i interpret delta ratio from this formula?? Or it is not gonna be possible to have this value on abg lab ?
Hi Eric, thanx for ur videos! this is awsome! just one question in example one u say AG is normal infact the calculated AG is 7 (133-92+34 can u pls explain! thanks!!
med studnt Sorry, I was speaking imprecisely. By saying that the "AG is normal", I really mean that the AG is not elevated. According to the normal range of anion gap discussed early in the video series, 7 is abnormally low. However, and I can't recall whether this is discussed in the 5th video on anion gap or not, but some labs have adopted new assays in recent years that have caused the normal range for the anion gap to change. I've heard of a normal range as low as 3-7 in some labs.
This series is the best explanation of acid-base disorders I have ever had!! Thank you sooooo much Eric!!
i completely agree!
I do not know how I can thank you
no one explained ABG in perfect way like you
thank you very much , as an internal medicine resident in a third world country these lectures will definitely improve my ability to take care of my patients
This series on acid-base is fabulous.
This is a great video series - really appreciate you taking the time to record and upload these !
man these cases are just soooooooooooooooo epic doc
Thank you so much! You have changed my life.
Thank you Éric, your lectures are amazing
Thanks!
Thank you so much!!!! Your lectures are really awesome!!!
Hello! Let me start by thanking you for your videos. The content and the way that you present it remarkable!!
I´d like to argue if in the last case discussed in this video (pregnant 32 year old with 4 days of vomiting), the elevated anion gap acidosis could be due to multiple causes, like acute serious renal failure (for a pregnant woman those BUN and Cr values are too high for comfort), plus the one that you mencioned, elevated lactate due to shock, plus ketoacidosis due to fasting.
Thank you so much Sir for your videos. Presentation is very appealing, and your knowledge is inspiring. During these trying times, it helps me prepare for managing the covid crisis. And please take care.
very nicely explained and great use of presentation skills to help reinforce key concepts. awesome video! I can see that these videos are a result of a lot of hard work and great teaching skills :D
Thank you so much for your amazing videos!
Gifted, thanks so much. I am a disciple.
Excellent session
Hi, Eric. Thank you so much! Your video is wonderful.
Thanks 👍
Well explained
Subscribed
In example 2 you said we will require her Urine pH among other investigations. Can you explain the significance of Urine pH in this case and how we can use that value to reach a diagnosis
Thanks for these excellent Lectures Dr Strong! Some intensivists advocate using hypothetical normal values to interpret ABGs some of which you have also mention - HCO3 - 24 but in addition to that pH - 7.4 so that > 7.4 as in ex 3 - alkalemia and vice versa and pCO2 of 40 as normal. Using these 3 "normal" values - my conclusions have been the same so far except for ex 3 where that would have generated a diagnosis of primary metabolic alkalosis and secondary respiratory acidosis (as opposed to the AGMA indicated)...just wanted to hear your perspective on this as it seems to have worked in most acid-base disorders that I have encountered so far with my little experience?
thank you very much. good lecture
Thank you so much it’s really helpful. I have one Q . In order to calculate delta gap do we use adj AG or measu AG.
Where we're you when I was in med school?!...Thanks!,,
Do you have any reference document about complex acid-base disorders in which the overall pH is normal, I found this problem has a little bit difficult to use for clinical?
YOU ARE THE BEST, HELOOO FROM SERBIA- VRNJACKA BANJA
Great lecture!
Hi Dr. Eric. Regarding the last example, here's a pregnant woman with PaCO2 of 42. Normally you would expect respiratory alkalosis in pregnancy (physiologically) . So could the diagnosis infact be high anion gap metabolic acidosis plus respiratory acidosis plus metabolic alkalosis ?
Excellent
Is it possible to have acidemia without acidosis or alkalemia without alkalosis?
Hello,Mr Eric
I was wondering in setting of patient like the example3 which has normal ph wide anion gap, but what if delta hco3=0 delta ratio would be infinity ,what could i interpret delta ratio from this formula?? Or it is not gonna be possible to have this value on abg lab ?
Thank you very much!
If a patient has normal anion gab but have metabolic alkalosis , delta ratio will be 0 so how to exclude metabolic alkalosis in case of NAG
Hi Eric, thanx for ur videos! this is awsome! just one question in example one u say AG is normal infact the calculated AG is 7 (133-92+34 can u pls explain! thanks!!
med studnt Sorry, I was speaking imprecisely. By saying that the "AG is normal", I really mean that the AG is not elevated. According to the normal range of anion gap discussed early in the video series, 7 is abnormally low. However, and I can't recall whether this is discussed in the 5th video on anion gap or not, but some labs have adopted new assays in recent years that have caused the normal range for the anion gap to change. I've heard of a normal range as low as 3-7 in some labs.
The new range used for anion gap is 3 to 11. Even uptodate uses this. A gap of 12 is not normal anymore. It is high.
were....hate autocorrect