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The Curbsiders Internal Medicine Podcast

Supercharge your learning as these board-certified Internists interview the experts to bring you clinical pearls, practice changing knowledge, and a healthy dose of humor. 

Mar 26, 2018

Dominate acid-base disturbances with the wisdom of @kidney_boy aka Joel Topf, MD, Chief of Nephrology at Kashlak Memorial Hospital.  Master his 5 key steps for interpreting acid-base disorders and decode any ABG, VBG, and BMP to find the primary disorder, and any other disorders tucked away in the ABG! Plus: Henderson-Hasselbach and pH simplified; the anion gap, should your correct it?; choice of IV fluid; osmolar gaps, methanol, ethylene glycol, isopropyl alcohol; and how metabolic disorders are like a boy band. Be sure to follow along the Dr. Topf’s brilliant acid-base powerpoint.

Written and produced by Joel Topf MD, Shreya Trivedi MD, Xavi Jimenez MD; Images by Hannah Abrams; Edited by Matthew Watto MD

Full show notes available at

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Time Stamps

  • 00:00 Announcement
  • 01:00 Disclaimer
  • 01:34 Intro
  • 02:45 The setup and guest bio
  • 03:15 How does Dr Topf compensate for difficulty
  • 07:10 What has helped Dr Topf become successful as an educator
  • 10:40 With which electrolyte do you most closely identify?
  • 14:05 Picks of the week
  • 16:05 Nephmadness explained
  • 19:50 Joel’s big picture look at acid base
  • 22:17 Acid base and logorhythmic scale
  • 24:28 A caution about ABGs
  • 27:23 Clinical case from Kashlak Memorial Hospital
  • 28:05 Misinterpretation of low bicarb on a metabolic panel
  • 29:20 Step 1 of acid base
  • 32:00 Metabolic disorders and One Direction
  • 35:15 Acidemia vs acidosis; alkalemia vs alkalosis
  • 37:52 Compensation for acid base disorders
  • 40:45 ABG apps and analyzers
  • 42:40 Step 2 Is there a second primary disorder? Use equations for determining if compensation is appropriate.
  • 51:31 How to determine if respiratory compensation is acute or chronic
  • 54:26 Step 3 The anion gap
  • 57:21 Correcting the anion gap
  • 60:33 What causes a low anion gap?
  • 63:58 Anion gap acidosis
  • 66:05 GOLDMARK
  • 69:15 Step 4 Is there an osmolar gap?
  • 71:48 Toxic ingestions: Methanol, ethylene glycol, and isopropyl alcohol
  • 76:15 Calculating the osmolar gap
  • 79:08 Step 5 Gap-gap calculation aka “the bicarbonate before”
  • 85:05 Choice of IV crystalloid fluid and when to use a bicarbonate drip
  • 88:15 Bicarbonate in DKA
  • 90:18 NephMadness plug
  • 91:10 Outro

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