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.
Normal anion gap met acidosis
High anion gap met acidosis
No acid base abnormality
High anion gap metabolic acidosis with metabolic alkalosis
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.