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submitted by brise(31),
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os I wsa sktuc on htis auebces ish UNB riinceaet/n irtao lde me to nkthi eh hda an tiinsicnr realn oftniyn.csud And a GPI2 hionnibtii woldu elad ot a eap-enlrr atzaio,em wehre het BNU/ irtceniena taori wodlu eb erom nath 0.2 I nwko htta IANDSs nbihiit PGSI. uBt hwo era yuo sspeopud to cssro tou icdiounnt of lsdita tlubuar sisi?coad

purdude  You can cross out Distal RTA because the urine pH is 5. In Distal RTA, urine pH becomes greater than 5.5 because a-IC cells can't secrete H+ +  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +  


submitted by sympathetikey(945),
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Mda ta lmsyef orf gaihcngn ym r.asnew

ualyFt lcoig emda em ornedw if ihnttgi yruo deah dwolu euscda erdcsiane PCI s,o keli a cshniug ecl,ru uoy luodw get iesecdanr aVsug rnvee aicitytv and eaymb ydcaarairdb + nheosopn.tiy tBu I egsus the ASAR ysemts ldwuo hvae actoernedtuc that dna asedcu scnnsiovacttooir oerv 24 huros, so eymiHoclvop sokhc si ltiindeefy eht stbe ich.ceo

Aalwsy dlhuso og whit teh oobsivu rsnwae ):

seagull  I had the idea that this was a neurogenic shock and increasing intracranial pressure could affect the vagus too. I think the question really wants us to go that direction. +7  
uslme123  The Cushing reflex leads to bradycardia! +4  
purdude  Wait I'm confused. I thought hypovolemic shock leads to an increased SVR? +2  
littletreetrunk  apparently, there's a thing called sympathetic escape that can happen after a while (i.e. he's been out for 24 hours): Accumulation of tissue metabolic vasodilator substances impairs sympathetic-mediated vasoconstriction, which leads to loss of vascular tone, progressive hypotension and organ hypoperfusion. +  
littletreetrunk  also also if he hit his head he could have loss of sympathetic outflow from a hypoxic medulla which could lead to vasodilation, which further reduces arterial pressure, but this was a hard one for me lol. I also put increased ICP wah. +  
catch-22  Any lack of sympathetic outflow/increased vagal outflow should reduce HR, not increase it. Further, you would expect brainstem signs if there was hypoxia to the brainstem. For example, if you had damage to the solitary nucleus, you wouldn't be able to regulate your HR in response to reduced BP. Since this patient has reduced BP and increased HR, this indicates that the primary disturbance is likely the reduced BP. He's also been in a desert for 24+ hours so. +3  
charcot_bouchard  In a patient who develops hypotension following high-energy trauma, neurogenic shock is a diagnosis of exclusion that is made after hypovolemic and obstructive cardiogenic shock have been ruled out! Plus Absent Bradycardia rules it out +1