MUDPILES

Methanol/Ethylene glycol
– visual sx
– Ca oxalate xtals
– Woods lamp
– Osm gap
MUDPILES

Uremia
– BUN/Creat


DKA
Paraldahyde
– pungent odor

Isoniazid
– hx TB Rx
MUDPILES

Lactic Acidosis
– Abd pain -> dead gut
– Decreased perfusion
– Liver failure
– Alcohols
– Meds
– Inborn errors
– Lactate -> 27
MUDPILES

Ethanol - Alcohol Ketoacidosis
– Binge drinker, Not eating

Salicylates
– Hx of ASA use
Alcohol ketoacidosis


Uncommon, often missed
Binge drinkers
AKA - 3 factors
1. Alcohol intake
2. Decreased caloric intake
3. Volume depletion
Results in starvation physiology
AKA

Decreased caloric intake
– Counter regulatory hormone release
– Epinephrine, cortisol, growth hormone
– Elevated glucagon, decreased insulin
– Promotes lipolysis and fatty acid
mobilization

Volume depletion
– Elevated glucagon, decreased insulin
AKA

Alcohol intake
– Oxidation of ETOH-> ->acetate
– NAD->NADH which raises glucagon,
decreases insulin
– Promotes betahydoxybutyrate vs
acetoacetate
– Decreased gluconeogenisis
AKA

Symptoms
– N, V, abd pain
– Dyspnea, tremulousness
– Muscle pain, fever, diarrhea, syncope, Sz

Physical
– Tacycardia, tachypnea, abdominal pain,
– Hepatomegaly, hypotension
AKA

Differential Dx
–
–
–
–
–
–
–
–
Cholecystitis
Peptic ulcer, gastritis
Mesenteric ischemia
Pacreatitis
Withdrawal syndromes
Metabolic acidosis
DKA
Methanol, Ethylene glycol
AKA - labs

pH –low, high or nl
– Metabolic acidosis -> ketones
– Metabolic alkalosis -> vomiting
– Respiratory alkalosis -> hyperventilation

Serum ketones low, high or nl
– Betahydoxybutyrate


Lytes –abnormal
Lactate – mildly elevated
AKA-treatment


Volume replace
Carbohydrate replacement
– D5NS

Fix electrolyte abnormalities
– K, Mg, acidosis

Address associated problems
– Withdrawal, Wernikes, GI bleed, hepatitis,
pancreatitis, pneumonia, rhabdo, etc.