NBME 20 Na+: 132; K+: 3.2; Cl−: 90; HCO3−: 37 (NBME Answers)

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Retired NBME 20 Answers

nbme20/Block 1/Question#37 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
Na⁺: 132; K⁺: 3.2; Cl⁻: 90; HCO3⁻: 37 🔍 / 📺 / 🌳 / 📖
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submitted by apop(8)

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eesTh sltxepnanioa teanr ge.tar It etdosn lryela vhea mhcu to od with ASRA ionv.atctia It sah tomasl hygiterven ot od iwht a eonphenomn leladc the klinalae .tide nI irocnhc t,onmtvgii you udolw pexcte l-C to be wlo adn =K ot be lwo l(smriai to abl eslstur ni omnseeo twih uiblal.m)e oT etmoaspnec for eth olw ,Cl- hte acmoths sha na poritnater iwhch snxgeahec lC- ofr H-3O.C heTorr,efe l-C iwll eb sihelrneedp ni het m,achtos ilwhe CH3O- lilw eiaecnsr in the o,odlb nagicus an o.lilsakas nI laacokitl etts,as het HK+/+ tpnrteroia llwi gineb to aievt,tca tgshinfi +K NOIT lcsle kaeapi)l(oyhm nad gsicanrnie pH. ASAR yapbblor aspyl a oerl in ikgmna hte peimhyokala rsoew utb het aklailen tied is moer orimapntt r.ehe

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spaceboy98 ntIs laleakni etdi eteldra to na cierensa ni Hp ratfe mel?as rouY ilgco is no oipnt tub 'Im tno urse ewrheth ew acn yaplp that tcepcno re.he +1

kevin poectnc nca eb alppdei reeh cusabee we nede ot epeltre eth -Cl in rrdoe ot cretae ;lHC eth otashmc tn'does rcae fi C-l is olw in use,rm nlyo ttha l-C si wol ni eht leaitrpa llecs and os wlli pmpu otu -H3OC ni sit nepxsee +

usmleaspirer wyh si +K ?owl +

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+6 upvote downvote
submitted by ∗hayayah(1212)

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hiWt ccoirnh gvntoi,im you leos seollrteecyt and a tlo fo ac.id tI stegrgri oecabtlmi alsaolisk whhic is hwy all eht urems eluasv ear lwo (or no hte wleor end of hte aomrnl ngear) tcepex for nira.btaeobc

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ergogenic22 drescedae K+ frm(o adnceseri RASA deu ot euomlv )sols and addrseeec -lC sol(s fo lHC morf hte hamco),ts aoAlsklis rfom sols of HlC dan usth hghi o .i ar cbFbr tish anseor ghhi to mdi ngaer K is wgnor +5

sbryant6 t'dWounl racdsenie AARS dlae to inesarcde a+N? heT eransw sohws rcdedsaee +N.a +3

sbryant6 so,Al rmeremeb iuaBiml reavsoN si sacaoisdet thiw yiaea.mkohlp +1

sugaplum so eth grnae tyeh evga rof K is ?3-6 so 23. is WLN eh?nt o r ear we tusj iargoetpn no it" si no the wrole ned fo nloarm ni eds"p +2

dbg usdoim evlsle ni pylrcio sontiess yvar, gnohint lylrae ci,casls nac eb gihh as ni ihst cesa ipylsm due to haydontir, acn olw ni ohret secsa if taooelrdnes nadameg ot veeserr atth ot the eorth etrxeem +1

skonys chpocrl"emoHiy, lakcyopmehi cialetmbo alsksiola si teh ccsiasl cyeoerletlt and eaicd-bsa bmneacial of copilry sest"soni rmfo eamsdpec ibhdne lpiywligta .mVano = euomlv sslo (cde knsi rug)ot as llwe sa lsso of +H, -lC and hNiwa+(t 0H)2 g&-t; eotclbaMi sa.sllikoA sLos of +H sueacs snceaire -3OCH riottnene as lewl as +K tsihf iton secll iehka(mloapy F9A1 )8.57 +

From amboss: The loss of gastric hydrochloric acid from emesis results in increased bicarbonate concentration in the blood and decreased chloride. Some potassium is also lost through vomiting. Hypovolemia leads to an activation of RAAS, which exacerbates metabolic alkalosis via increased bicarbonate reabsorption (as a result of angiotensin II). Aldosterone also causes renal secretion of potassium and hydrogen ions, further exacerbating both hypochloremia and metabolic alkalosis.

+10/- smpate(20)

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+5 upvote downvote
submitted by ∗masonkingcobra(408)

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nI toibmclea oi,lasaskl itsopsaum sveom iont eht eclsl

The slos ni voumel hurhgot msesie sigtrrge ASRA itulesrng ni dieseracn nldeesorotA esaleer adn hrreftu ampssiout ecxiterno

p/6nlbt:t.1s/a/eat.dw/1ehpwtwtei

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submitted by iamapotato(3)

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No oen here tbderhoe to lautaylc discuss 'awsht ggnoi Tohsn. i si a nho1mt- dlo bnrnoe.w

eH vosimt fatre sfdieegn, da5y- ryios.th

tA 1 nhtmo lo,d tiwh tivgomin afret ,sdingeef ti is omst keyill a aecs of LCRPOYI SISNSTOE edu to ytoyrprhphe of teh yrpiolc rspnetich l(yaulsu socucr 6 kewse ler)ta.

Deu ot ihm imngvoit osmhtca tosentn,c he llwi LOSE ,-Cl ,+K dna +Na.

eH will LSAO osel H+. sThi si hyw ouy og oint teh ecabiomtl laiskosla wiht a trlsuante erincesa in eht CO-H3.

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kamilia20 cst:yeh:k gmitvoin csesua slso of TWRAE ergetar tnah uiomsd→ raecseind eurms →siodum RECANSEDI rmeus s,lmyltiaoo So AN iwll caedsree to,o utb no ahtt afr +

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+1 upvote downvote
submitted by ark110(1)

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tBu thaw is eht ednecfrefi teneebw pinoot A nad noitpo C ;13(2 ;.49 ;09 53)

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sympathetikey +K ln'hsotud e.nscreai 'tsI ingmvo oint sllce eud ot eltmcaoib aki.lolssa +

home_run_ball In hte perltaai llec fo het ortgds meHco yh an nois are edofmr fomr het ciianidossto of ribccnoa d.iac rtaWe si a eyvr morin recsou fo ogyrhend oisn ni mpianosorc ot canbicor ida.c Cricnoab cadi is oedmfr fomr brnaco idoiexd nda warte yb broaicnc dhae ranes .Tyh ebbnciataor ino O3()H−C is edhnecgxa for a doeichlr ino ()Cl− on het asabl deis of het ecll nda teh canbiaretbo ssefudif tnio het nuosve dl,oob endalgi to na aeaillnk dtei ennmohen.op +1

ergogenic22 AARS saresncie fmro uleovm osl,s dan usth moer lndoesatore eadsl to wol +K +1

sinforslide eehTr oenarss for khiyolam.eap irsF ,t omes +K is otsl in ictarsg ul.sdfi cS neo,d H+ fsshti otu fo selcl nda +K thfiss niot eclsl in tclmabieo .sk,aolThidals ir EFC ovleum tonctaonric sah ucdsae eecdaisnr ericnoets of odoasl.etern +3

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submitted by ∗rainlad(33)

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moclp,yohcireH ycpimehlaok itemalcob ksioalsla is teh aiscscl lrtyteolece dan -saacedbi naecbalmi fo plryioc etsssion.

stPsnetrei tgiinvom tsesurl in osls of H.lC heT clihdreo sslo slsture in a lwo ldboo cedrihol lvlee chwhi miaiprs eth 'deknisy btyiial ot xereetc tnabacboeri. Tshi si the ctfaor atth sntverpe ocrrnitoec fo eht kslalioas igdelna ot btoliaecm iaslakslo.

A dcanorsey ylorhsetnroapesdmi sveolpde ude ot het ddrecasee boold o.mluev ehT high ntlerdaeoos vlsele usscae hte seiynkd ot rtinea +Na ot( oecrrtc the uisrranalvtca uevlom lnpe,)itode and xrceeet reencdias osatmun fo K+ niot the rneui nsirule(tg ni a low dloob level of .is)mtosapu

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submitted by thefoggymist(12)

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I tdn'o egt ihts. dS'ountlh the dkseyin astrt ercroginct the cbrbia vesell eraf 5 sday? heT ddealye sphae fo hte cotoirernc icsen ythe eatk .emti.. dan ni hte niseqotu hetry'e gkasin . wn"eoW" aevh otmelbaic lasksiola esinc HCL is l,ost os hte ydbo lwil rty ot crctore it rstif by irvpohntaeintyel nad eratl by dseinrcae oxceitern fo abcb.ri raBibc ldsuoh eb .o.l.w eusl(sn mI' nmssiig niostgmhe due ot gbien xthuesae)d

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thefoggymist Nervn,imed I khitn I tgo ti. aeBt eetiaranctld lslce nnotac tnnfuoic adn treecex bbacir basueec ew 'ndto have ehridcol. aeY raeppntlay I aws th.xesuead +

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submitted by ∗amirmullick3(76)

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eVry eysa i.oqusten nbNioiosul itmo.v 1 mhnto age. oMst lylkie aenircso is rcpyilo sot.sesin

Teh vinogimt scsaeu sols fo HCl os we avhe eth ohalyeh,mcoipr adn rlena ienmcoopstna for sith H loss bs yi rsgeirpnev tprsono at het nsexeep of K os thta ivegs kaoapiyhelm. sA hte aeseids si ,dmaen hte awrerrdo in hte geima fo hte hctosam si tohmso ecmlsu ehtrprpyoyh of eth yrpocil msrsuluaic osmeua,c mtfhinoerg le-idvsahpeo smsa elft no ioan.ptapl isTh is a cebmtaoil llksaasio uesbeca wotthiu l,C- eht Hl/Oo3aaasCetCllrb aeegrnxhc lilw not k,orw os you entira H3.CO

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