A 20-year-old female presents with weakness of all
four limbs of one days duration.
She had a history of similar episodes in the past.
No other significant illnesses in the past. She is not on any drugs.
No significant family history.
On examination her general condition was satisfactory,
no signs of thyrotoxicosis.
Conscious alert rational, cranial nerves normal. On
examination of her limbs there was no wasting, tone was decreased, weakness of
all four limbs unable to move them against gravity tendon reflexes were normal
no sensory loss. No other abnormality of note.
Blood sugar 5.7 mmol/l
Na 138 mmol/l
K 2.0 mmol/l
Chloride 112 mmol/l
Blood urea 5.0 mmol/l
Pa CO 2 3.8 kPa
Pa O2 13.0 kPa
Urine pH 7
In this patient treatment should be:
Give iv Potassium before bicarbonate
Give iv bicarbonate before potassium
Give iv bicarbonate alone
Give iv potassium alone
Give iv calcium
In this patient the underlying diagnosis is:
Proximal renal tubular acidosis
Distal renal tubular acidosis
Type A L- lactic acidosis
Type B L-lactic acidosis