Findings: methanol, uremia, DKA, paraaldehyde, iron ingestion, lactic acid, ethanol or ethylene glycol, salicylates
Notes: MUDPILES. Should see normal chloride and low bicarbonate
Question: Do these conditions cause an anion gap or non-anion gap metabolic acidosis?
Central Diabetes Insipidus
Category: generalpediatrics-Electrolytes
Findings: hypernatremia, polyuria, dilute urine with low osmolality, treated with DDAVP
Notes: If diagnosis is confirmed obtain brain imaging and pituitary hormones.
Question: What fits these findings?
Cerebral Salt Wasting
Category: generalpediatrics-Electrolytes
Findings: hyponatremia, high urine sodium and osmolality, hypotension, poor skin turgor, seizures
Notes: Similar to SIADH but has a volume-depleted state instead of being euvolemic or hypervolemic
Question: What fits these findings?
Chloride Responsive
Category: generalpediatrics-Electrolytes
Findings: vomiting, dehydration and contraction alkalosis, loop or thiazide diuretics
Notes: You may need to treat with a normal saline bolus, if there is contraction alkalosis. You will see a urine chloride less than 15 as the body is trying to hold onto chloride.
Question: Do these cause a chloride responsive or unresponsive metabolic alkalosis?
Findings: high urine output, hypernatremia, lack of response to DDAVP, X-linked recessive
Notes: Treat with salt restriction and hydrochlorothiazide
Non-anion Gap
Category: generalpediatrics-Electrolytes
Findings: diarrhea, small bowel fistula, carbonic anhydrase inhibitors such as acetazolamide, rental tubular acidosis, adrenal insufficiency, ureterostomy
Notes: Will see hyperchloremia and low bicarbonate level
Question: Do these conditions cause an anion gap or non-anion gap metabolic acidosis?
Renal Tubular Acidosis Type 1
Category: generalpediatrics-Electrolytes
Findings: hypokalemia, caused by inability to excrete hydrogen ions, urine pH more than 5.5, associated with autoimmune conditions
Renal Tubular Acidosis Type 2
Category: generalpediatrics-Electrolytes
Findings: hypokalemia, caused by loss of bicarbonate in urine, urine pH less than 5.5
Renal Tubular Acidosis Type 4
Category: generalpediatrics-Electrolytes
Findings: hyperkalemia, urine pH less than 5.5, seen in hypoaldosteronism and diabetes
Syndrome Of Inappropriate ADH Secretion (SIADH)
Category: generalpediatrics-Electrolytes
Findings: increased total body water, low urine output, low serum osmolality, hyponatremia, high urine osmolarity and sodium, treated with fluid restriction
Notes: If persists despite fluid restriction, treat with diuretic or fludrocortisone. Kidney is holding onto water but losing sodium as there is a hypervolemic state.