5 step approach to acid base disorders. Steps 4 and 5 are for the true internists!
Step 1. What is the primary disorder?
a) acidosis (pH <7.4) or alkalosis (pH >7.4).
b) primary respiratory (PCO2) or metabolic (HCO3) disorder. Ie if the PCO2 is high, and pH is low then it is a respiratory acidosis.
Step 2. Is there adequate metabolic or respiratory compensation?
a) metabolic acidosis: Winter’s formula. 1.5 x [HCO3] + 8 +- 2.
b) metabolic alkalosis: PCO2 should increase to two-thirds the increase in HCO3. Ie if HCO3 is 6 mmol/l above the upper limit, then the PCO2 should increase by 4 mmHg.
c) Respiratory acidosis: HCO3 increases 1mmol/l for acute compensation or 3 mmol/l for chronic compensation for every 10mmHg increase in CO2.
d) Respiratory alkalosis: HCO3 decreases by 2mmol/l for acute compensation or 4mmol/l for chronic compensation every 10 decrease in CO2.
Step 3. If there is metabolic acidosis. Is there an anion gap?
a) Anion gap = Na – (HCO3 + Cl). If greater than 12, then high anion gap metabolic acidosis. Note that for every 1g/dl drop in albumin, increase anion gap by 2.5 because albumin is a major unmeasured anion.
Step 4. If there is a high anion gap metabolic acidosis, is there an osmolar gap?
a) measure osmolar gap if you suspect a toxic alcohol ingestion such as methanol or ethylene glycol.
b) osmolar gap = serum osmolality – calculated osmolarity. Should normally be less than 10.
c) calculated osmolarity = 2 x [Na] + [glucose] + [urea]. Note this does not include alcohols and thus an osmolar gap >10, should consider alcohol, ethylene glycol or methanol ingestion.
Step 5. If there is a high anion gap metabolic acidosis, is there also a concomitant normal anion gap metabolic acidosis?
a) delta HCO3 should equal delta anion gap. Ie. 24 – HCO3 = AG – 12. If not within +- 2, then there is also an underlying normal anion gap metabolic acidosis
Playing with Perception.
Little geometric studies.
Artist in Residence
Centre for Substructured Loss London
Today marks the beginning of my journey back into large-scale work. Hopefully a little more refined (and easier to transport!) than the last, looking forward to getting some pieces of work finished before I leave this place!
Digital Artist Residency & Magdalen Road Studios @magdalenarts
present: ✅ Remember Me. OPEN CALL – Digital residency at DAR During Feb-March & exhibition at Gallery 8, Magdalen Road Studios, Oxford.
DAR is looking for 6 - 8 artists for a group show and online residency.
DAR is looking for proposals for ambitious net art, interactive online projects and digital works which respond to DAR's online context and develop into a physical work for the exhibition. For more info, follow the link in bio.
#opencall #netart #residency #rememberme
Wall of Fame: Come over to be’kech tonight to hear Armeghan Taheri, an Afghan-German writer and actress working on the intersection between art and social justice. In her literary practice she aims to turn legacies of trauma, loss, survival and immigration into intellectual and political power. She is the founder of „What’s Afghan Punk Rock anyway?“ and a resident at Be’kech.
In our first event with @ar.meghan
, she will be telling stories about her life, work and upcoming projects - addressing topics such as #gender #queerness #racism #mentalhealth
and taboos experienced by Muslims living in the diaspora. We are so excited!
Facebook event here: https://m.facebook.com/events/551193005304689 - Event starts at 730pm tonight, so don’t miss out!
Andddd...if you want to submit to the zine, “What’s Afghan Punk Rock anyway?” - you can! Check the fb event above for more info. .
#bekech #berlin #zine #activism #queer #berlinevents #muslim #stories #taboos #storiesuntold #coworking #coworkingspace #residency #artist #germany #mentalhealth
The Snowball Effect project grows every day. We're working on the the idea of community and identity. One of the activities will be building a village with the public, and Fabrice is taking care of it.
"Some people have asked me why I would want this. I mean, medical school life is hard enough already with studying and clinics and everything else, without being responsible for and accountable to a class full of Type-A personality medical students. But the truth is, I do want this. And it's because, as corny warm fuzzies roll-your-eyes as it might be... it's because I really do care. Through this position, I feel that I would be able to effect change and innovation through service for the benefit of everyone. I honestly believe that as the Class of 2010 we are the best class ever, and I want to set the bar high.
"Like a lot of you, I left everything to be here. I left all of my friends and I left my family, which basically consists of my single-parent mother whom I love to death. Like so many of you, I left everything... to study medicine here at Northwestern. For that decision to be completely worthwhile, I need to build something worthwhile here for me, but most importantly, for all of you.
"Thank you for your time and again my name is Martin Pham. I hope I get the opportunity to represent you, the best Feinberg class ever, the Class of 2010."
- notes from MS1, 2006
medical school class president speech
slide 7, "because I really do care"
my brief 4-year stint in the political limelight before i disappeared back into the anonymity of hard work and yes how high
#neurosurgery #surgery #residency #training #medicalschool #medschool #medicalstudent #medstudent #premed #northwestern #classpresidents
:: Today I had some time to edit & came across this gem of an excerpt from a chapter I started on finances this past July...
was a good read & I HIGHLY recommend it by David Bach...
The whole process of #medicalschool
is expensive & add life in general to the mix and things happen. We started out as newlyweds going in & I read this and got a better understanding. Knowing more before, during or after is still beneficial. #themoreyouknow
American Society for Metabolic & Bariatric Surgery conference ❤️
Today is #worldkindnessday
and yet this week I’ve had to give a lot of bad news and have seen too much tragedy. However, I choose to focus on what a blessing this profession is and how grateful I am to be able to use my role in medicine for kindness toward every family I meet. #choosekindness #youarenevertooimportanttobekind
It may not be easy but it is so worth it.
After two months of inpatient hospital medicine, I am back in the outpatient world for the week.
I was rusty this morning.
It takes time to get used to doing your notes with the patient there.
It's a struggle to remember the appropriate questions for conditions you aren't 100 % confident in.
It’s part of the process. I had to review some topics after I left work this evening. And while it may have been a rough start, there was that moment in my day that made it incredibly worth it.
When your patient asks if he could hug you at the end of your visit because you listened to his concerns.
Life is going to face you with challenges, look towards the little moments that make each day brighter. •
#residency #littlemoments #roughstart
Introducing Rayn Ahmed, born Nov 1, 2018. Mashallah. This pregnancy was rough but the delivery was a breeze 🙏 I chose this pic because it shows how big my “village” is. Having two babies in training with a hubby who is busier than I am was tricky. The only way I survived is with the help of my family and extended family who has been around literally 24/7 bringing food, tag-teaming watching the older baby, and helping around the house. In this day and age with everyone so busy being pulled in a million directions, having the help is beyond priceless.
And that’s a wrap 💯. Thank you @AASLD
, and my mentors/friends for a wonderful experience at this year’s liver meeting 😌. .
Livers of liverlovers now need some chill time 😂🌚 Lastly, wishing the best for my friends matching at the end of this month 🙌🏼🙌🏼🙌🏼