SlideShare ist ein Scribd-Unternehmen logo
1 von 32
Interesting Case Conference
THE CASE ,[object Object],[object Object],[object Object],[object Object]
THE CASE ,[object Object]
THE ANION GAP
THE ANION GAP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
KETOACIDOSIS
KETOACIDOSIS
KETOACIDOSIS
KETOACIDOSIS
KETOACIDOSIS
LACTIC ACIDOSIS
LACTIC ACIDOSIS
Increased lactate production ,[object Object],[object Object],[object Object],[object Object]
Increased lactate production ,[object Object],[object Object],[object Object],[object Object]
Increased lactate production ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Increased lactate production ,[object Object],[object Object],[object Object],[object Object],[object Object]
Primary decrease in lactate utilization ,[object Object],[object Object],[object Object]
Mechanism uncertain ,[object Object],[object Object],[object Object],[object Object],[object Object]
UREMIA
TOXINS
TOXINS
Toxins Isopropanol is primarily metabolized via alcohol dehydrogenase to acetone
TOXINS
TOXINS
Clinical course in acute ethylene glycol intoxication  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical course in acute ethylene glycol intoxication 12 to 24 hours  Cardiovascular  Mild hypertension, tachycardia, and shock      Pulmonary  Tachypnea adult respiratory distress syndrome pulmonary edema pneumonitis      Metabolic  Metabolic acidosis with elevated anion gap  decreased osmolal gap possible tetany from hypocalcemia, and hyperventilation
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TOXINS
TOXINS
TOXINS
TOXINS
Conclusion ,[object Object],[object Object],[object Object]

Weitere Àhnliche Inhalte

Was ist angesagt?

Hyper and hypocalcemia
Hyper and hypocalcemiaHyper and hypocalcemia
Hyper and hypocalcemiaGowtham Manimaran
 
Coma final
Coma finalComa final
Coma finalashabdou
 
Hyperkalemia
HyperkalemiaHyperkalemia
HyperkalemiaAMRUTHA JOSE
 
Altered consciousness
Altered consciousnessAltered consciousness
Altered consciousnessMukhtar Khan
 
Rhabdomyolysis
RhabdomyolysisRhabdomyolysis
Rhabdomyolysisfathi neana
 
PREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATION
PREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATIONPREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATION
PREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATIONBruce Vincent
 
Myelomeningocele
MyelomeningoceleMyelomeningocele
MyelomeningoceleNabaz Mohammed
 
Hyperosmolar hyperglycaemic state
Hyperosmolar  hyperglycaemic  stateHyperosmolar  hyperglycaemic  state
Hyperosmolar hyperglycaemic stateDr. Tanmoy Roy
 
3. initial assessment and triage in er ppt
3. initial assessment and triage in er ppt3. initial assessment and triage in er ppt
3. initial assessment and triage in er pptGirish Kumar
 
Fluids And Electrolytes
Fluids And ElectrolytesFluids And Electrolytes
Fluids And ElectrolytesMD Specialclass
 
Fluid & Electrolyte balance by Dr Nesar
Fluid & Electrolyte balance by Dr NesarFluid & Electrolyte balance by Dr Nesar
Fluid & Electrolyte balance by Dr NesarStudent
 
Approach to a case of motor and sensory disorders
Approach to a case of motor and sensory disordersApproach to a case of motor and sensory disorders
Approach to a case of motor and sensory disordersChitralekha Khati
 
Parathyriod ppt presentation
Parathyriod ppt presentationParathyriod ppt presentation
Parathyriod ppt presentationwondimeneh shibabaw
 
Increased Intracranial Pressure
Increased Intracranial PressureIncreased Intracranial Pressure
Increased Intracranial PressureTosca Torres
 
Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...
Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...
Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...guestee72a042
 
TAEM10:Electrolyte emergency
TAEM10:Electrolyte emergencyTAEM10:Electrolyte emergency
TAEM10:Electrolyte emergencytaem
 
Geriatric Trauma_January 2011
Geriatric Trauma_January 2011Geriatric Trauma_January 2011
Geriatric Trauma_January 2011dbakes
 

Was ist angesagt? (20)

Hyper and hypocalcemia
Hyper and hypocalcemiaHyper and hypocalcemia
Hyper and hypocalcemia
 
Coma final
Coma finalComa final
Coma final
 
hyponatremia
hyponatremiahyponatremia
hyponatremia
 
Initial Assess Trauma
Initial Assess TraumaInitial Assess Trauma
Initial Assess Trauma
 
Hyperkalemia
HyperkalemiaHyperkalemia
Hyperkalemia
 
Altered consciousness
Altered consciousnessAltered consciousness
Altered consciousness
 
Hypernatremia
HypernatremiaHypernatremia
Hypernatremia
 
Rhabdomyolysis
RhabdomyolysisRhabdomyolysis
Rhabdomyolysis
 
PREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATION
PREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATIONPREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATION
PREVIEW OF EMT/EMR GERIATRIC EMERGENCIES POWERPOINT TRAINING PRESENTATION
 
Myelomeningocele
MyelomeningoceleMyelomeningocele
Myelomeningocele
 
Hyperosmolar hyperglycaemic state
Hyperosmolar  hyperglycaemic  stateHyperosmolar  hyperglycaemic  state
Hyperosmolar hyperglycaemic state
 
3. initial assessment and triage in er ppt
3. initial assessment and triage in er ppt3. initial assessment and triage in er ppt
3. initial assessment and triage in er ppt
 
Fluids And Electrolytes
Fluids And ElectrolytesFluids And Electrolytes
Fluids And Electrolytes
 
Fluid & Electrolyte balance by Dr Nesar
Fluid & Electrolyte balance by Dr NesarFluid & Electrolyte balance by Dr Nesar
Fluid & Electrolyte balance by Dr Nesar
 
Approach to a case of motor and sensory disorders
Approach to a case of motor and sensory disordersApproach to a case of motor and sensory disorders
Approach to a case of motor and sensory disorders
 
Parathyriod ppt presentation
Parathyriod ppt presentationParathyriod ppt presentation
Parathyriod ppt presentation
 
Increased Intracranial Pressure
Increased Intracranial PressureIncreased Intracranial Pressure
Increased Intracranial Pressure
 
Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...
Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...
Paraplegia By Dr Bashir Ahmed Dar Associate Professor of Medicine Chinkipora ...
 
TAEM10:Electrolyte emergency
TAEM10:Electrolyte emergencyTAEM10:Electrolyte emergency
TAEM10:Electrolyte emergency
 
Geriatric Trauma_January 2011
Geriatric Trauma_January 2011Geriatric Trauma_January 2011
Geriatric Trauma_January 2011
 

Andere mochten auch

Anion gap
Anion gapAnion gap
Anion gap01111992
 
Friedreich ataxia case pres by dr adeel
Friedreich ataxia case pres by dr adeelFriedreich ataxia case pres by dr adeel
Friedreich ataxia case pres by dr adeelWest Medicine Ward
 
Baron coburg ppt Case Study and all
Baron coburg ppt Case Study and allBaron coburg ppt Case Study and all
Baron coburg ppt Case Study and allCharliez Jane Soriano
 
Friedreich’s Ataxia
Friedreich’s AtaxiaFriedreich’s Ataxia
Friedreich’s Ataxialiptontea1995
 
An approach to a child with abnormal movement
An approach to a child with abnormal movementAn approach to a child with abnormal movement
An approach to a child with abnormal movementSunil Agrawal
 
Friedreich's ataxia
Friedreich's ataxiaFriedreich's ataxia
Friedreich's ataxiazubair314
 
03 01-06 approach to ataxia
03 01-06 approach to ataxia03 01-06 approach to ataxia
03 01-06 approach to ataxiaAndrea Pardo
 
Renal tubular acidosis and other causes of Normal anion gap Metabolic acidosis
Renal tubular acidosis and other causes of Normal anion gap Metabolic acidosisRenal tubular acidosis and other causes of Normal anion gap Metabolic acidosis
Renal tubular acidosis and other causes of Normal anion gap Metabolic acidosisJagjit Khosla
 

Andere mochten auch (13)

Anion gap
Anion gapAnion gap
Anion gap
 
Anion gap
Anion gapAnion gap
Anion gap
 
Case record...Friedreich ataxia
Case record...Friedreich ataxiaCase record...Friedreich ataxia
Case record...Friedreich ataxia
 
Friedreich ataxia case pres by dr adeel
Friedreich ataxia case pres by dr adeelFriedreich ataxia case pres by dr adeel
Friedreich ataxia case pres by dr adeel
 
Baron coburg ppt Case Study and all
Baron coburg ppt Case Study and allBaron coburg ppt Case Study and all
Baron coburg ppt Case Study and all
 
Lactic Acidosis
Lactic AcidosisLactic Acidosis
Lactic Acidosis
 
Friedreich’s Ataxia
Friedreich’s AtaxiaFriedreich’s Ataxia
Friedreich’s Ataxia
 
An approach to a child with abnormal movement
An approach to a child with abnormal movementAn approach to a child with abnormal movement
An approach to a child with abnormal movement
 
AniĂłn gap
AniĂłn gapAniĂłn gap
AniĂłn gap
 
Ataxia yash final
Ataxia yash finalAtaxia yash final
Ataxia yash final
 
Friedreich's ataxia
Friedreich's ataxiaFriedreich's ataxia
Friedreich's ataxia
 
03 01-06 approach to ataxia
03 01-06 approach to ataxia03 01-06 approach to ataxia
03 01-06 approach to ataxia
 
Renal tubular acidosis and other causes of Normal anion gap Metabolic acidosis
Renal tubular acidosis and other causes of Normal anion gap Metabolic acidosisRenal tubular acidosis and other causes of Normal anion gap Metabolic acidosis
Renal tubular acidosis and other causes of Normal anion gap Metabolic acidosis
 

Ähnlich wie Gap Acidosis

Fluid and electrolyte imbalance
Fluid and electrolyte imbalanceFluid and electrolyte imbalance
Fluid and electrolyte imbalancefrank jc
 
Body electrolytes.pdf
Body electrolytes.pdfBody electrolytes.pdf
Body electrolytes.pdfABSammad
 
Metabolic complication of peritoneal dialysis
Metabolic complication of peritoneal dialysisMetabolic complication of peritoneal dialysis
Metabolic complication of peritoneal dialysisIPMS- KMU KPK PAKISTAN
 
Liver failure by dr magdi sasi 2015
Liver failure by dr magdi sasi 2015Liver failure by dr magdi sasi 2015
Liver failure by dr magdi sasi 2015cardilogy
 
inborn error of metabolism
inborn error of metabolisminborn error of metabolism
inborn error of metabolismzahid mehmood
 
La2009
La2009La2009
La2009Deep Deep
 
Acid_base_balance_disorders.pptx
Acid_base_balance_disorders.pptxAcid_base_balance_disorders.pptx
Acid_base_balance_disorders.pptxNeha Verma
 
Acid Base disorders.ppt
Acid Base disorders.pptAcid Base disorders.ppt
Acid Base disorders.pptssuser0622881
 
Iem 2
Iem 2Iem 2
Iem 2bnavabi
 
iap-ahmedabad-inborn error of metabolism
iap-ahmedabad-inborn error of metabolismiap-ahmedabad-inborn error of metabolism
iap-ahmedabad-inborn error of metabolismNilu Panch
 
Organic Acidemias Didactic Bb Day1 3 Jh
Organic Acidemias Didactic Bb Day1 3 JhOrganic Acidemias Didactic Bb Day1 3 Jh
Organic Acidemias Didactic Bb Day1 3 JhSIMD
 
alchol electro. by dr agho.pptx
alchol electro. by dr agho.pptxalchol electro. by dr agho.pptx
alchol electro. by dr agho.pptxagho john
 
Abg intepretation case scenario
Abg  intepretation case scenarioAbg  intepretation case scenario
Abg intepretation case scenarioKamal Mergani
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarumpriya saxena
 
approach to inborn error of metabolism dr.mounika
approach to inborn error of metabolism  dr.mounikaapproach to inborn error of metabolism  dr.mounika
approach to inborn error of metabolism dr.mounikaDr Praman Kushwah
 
Nephrotic syndrome final
Nephrotic syndrome finalNephrotic syndrome final
Nephrotic syndrome finalakilav99
 
Ethanol toxicity
Ethanol toxicityEthanol toxicity
Ethanol toxicityscorpiodragon
 

Ähnlich wie Gap Acidosis (20)

Fluid and electrolyte imbalance
Fluid and electrolyte imbalanceFluid and electrolyte imbalance
Fluid and electrolyte imbalance
 
Body electrolytes.pdf
Body electrolytes.pdfBody electrolytes.pdf
Body electrolytes.pdf
 
Metabolic complication of peritoneal dialysis
Metabolic complication of peritoneal dialysisMetabolic complication of peritoneal dialysis
Metabolic complication of peritoneal dialysis
 
Liver failure by dr magdi sasi 2015
Liver failure by dr magdi sasi 2015Liver failure by dr magdi sasi 2015
Liver failure by dr magdi sasi 2015
 
inborn error of metabolism
inborn error of metabolisminborn error of metabolism
inborn error of metabolism
 
La2009
La2009La2009
La2009
 
Acid_base_balance_disorders.pptx
Acid_base_balance_disorders.pptxAcid_base_balance_disorders.pptx
Acid_base_balance_disorders.pptx
 
Acid Base disorders.ppt
Acid Base disorders.pptAcid Base disorders.ppt
Acid Base disorders.ppt
 
Iem 2
Iem 2Iem 2
Iem 2
 
iap-ahmedabad-inborn error of metabolism
iap-ahmedabad-inborn error of metabolismiap-ahmedabad-inborn error of metabolism
iap-ahmedabad-inborn error of metabolism
 
Organic Acidemias Didactic Bb Day1 3 Jh
Organic Acidemias Didactic Bb Day1 3 JhOrganic Acidemias Didactic Bb Day1 3 Jh
Organic Acidemias Didactic Bb Day1 3 Jh
 
alchol electro. by dr agho.pptx
alchol electro. by dr agho.pptxalchol electro. by dr agho.pptx
alchol electro. by dr agho.pptx
 
Abg intepretation case scenario
Abg  intepretation case scenarioAbg  intepretation case scenario
Abg intepretation case scenario
 
Quizlet-inborn errors
Quizlet-inborn errorsQuizlet-inborn errors
Quizlet-inborn errors
 
Hyperemesis gravidarum
Hyperemesis gravidarumHyperemesis gravidarum
Hyperemesis gravidarum
 
approach to inborn error of metabolism dr.mounika
approach to inborn error of metabolism  dr.mounikaapproach to inborn error of metabolism  dr.mounika
approach to inborn error of metabolism dr.mounika
 
Nephrotic syndrome final
Nephrotic syndrome finalNephrotic syndrome final
Nephrotic syndrome final
 
Seco dka
Seco dkaSeco dka
Seco dka
 
Ethanol toxicity
Ethanol toxicityEthanol toxicity
Ethanol toxicity
 
Lactate by jack.
Lactate by jack.Lactate by jack.
Lactate by jack.
 

Mehr von Joel Topf

Hyperkalemia, an update
Hyperkalemia, an updateHyperkalemia, an update
Hyperkalemia, an updateJoel Topf
 
Diabetic kidney disease
Diabetic kidney diseaseDiabetic kidney disease
Diabetic kidney diseaseJoel Topf
 
Low anion gap
Low anion gapLow anion gap
Low anion gapJoel Topf
 
Herbal toxins grand rounds feb 2014
Herbal toxins grand rounds feb 2014Herbal toxins grand rounds feb 2014
Herbal toxins grand rounds feb 2014Joel Topf
 
Acute Kidney Injury 2013
Acute Kidney Injury 2013Acute Kidney Injury 2013
Acute Kidney Injury 2013Joel Topf
 
Prescribing an app
Prescribing an appPrescribing an app
Prescribing an appJoel Topf
 
Creatine supplements
Creatine supplementsCreatine supplements
Creatine supplementsJoel Topf
 
Social Media in Health Care
Social Media in Health CareSocial Media in Health Care
Social Media in Health CareJoel Topf
 
Imaging in Acute Kidney Injury, how not to harm patients
Imaging in Acute Kidney Injury, how not to harm patientsImaging in Acute Kidney Injury, how not to harm patients
Imaging in Acute Kidney Injury, how not to harm patientsJoel Topf
 
AKI Lecture 2010
AKI Lecture 2010AKI Lecture 2010
AKI Lecture 2010Joel Topf
 
Uric Acid, Fructose and Hypertension
Uric Acid, Fructose and HypertensionUric Acid, Fructose and Hypertension
Uric Acid, Fructose and HypertensionJoel Topf
 
Hyponatremia
HyponatremiaHyponatremia
HyponatremiaJoel Topf
 
Diabetic Nephropathy 2009
Diabetic Nephropathy 2009Diabetic Nephropathy 2009
Diabetic Nephropathy 2009Joel Topf
 
Osmolar Gap
Osmolar GapOsmolar Gap
Osmolar GapJoel Topf
 
Sodium dreadnaught
Sodium dreadnaughtSodium dreadnaught
Sodium dreadnaughtJoel Topf
 
Electrolyte Free Water Clearance
Electrolyte Free Water ClearanceElectrolyte Free Water Clearance
Electrolyte Free Water ClearanceJoel Topf
 
The Two Faces of Geriatric Kidney Disease
The Two Faces of Geriatric Kidney DiseaseThe Two Faces of Geriatric Kidney Disease
The Two Faces of Geriatric Kidney DiseaseJoel Topf
 
Whats New In Potassium
Whats New In PotassiumWhats New In Potassium
Whats New In PotassiumJoel Topf
 
Lead Time Bias
Lead Time BiasLead Time Bias
Lead Time BiasJoel Topf
 
Electrolyte Vignette
Electrolyte VignetteElectrolyte Vignette
Electrolyte VignetteJoel Topf
 

Mehr von Joel Topf (20)

Hyperkalemia, an update
Hyperkalemia, an updateHyperkalemia, an update
Hyperkalemia, an update
 
Diabetic kidney disease
Diabetic kidney diseaseDiabetic kidney disease
Diabetic kidney disease
 
Low anion gap
Low anion gapLow anion gap
Low anion gap
 
Herbal toxins grand rounds feb 2014
Herbal toxins grand rounds feb 2014Herbal toxins grand rounds feb 2014
Herbal toxins grand rounds feb 2014
 
Acute Kidney Injury 2013
Acute Kidney Injury 2013Acute Kidney Injury 2013
Acute Kidney Injury 2013
 
Prescribing an app
Prescribing an appPrescribing an app
Prescribing an app
 
Creatine supplements
Creatine supplementsCreatine supplements
Creatine supplements
 
Social Media in Health Care
Social Media in Health CareSocial Media in Health Care
Social Media in Health Care
 
Imaging in Acute Kidney Injury, how not to harm patients
Imaging in Acute Kidney Injury, how not to harm patientsImaging in Acute Kidney Injury, how not to harm patients
Imaging in Acute Kidney Injury, how not to harm patients
 
AKI Lecture 2010
AKI Lecture 2010AKI Lecture 2010
AKI Lecture 2010
 
Uric Acid, Fructose and Hypertension
Uric Acid, Fructose and HypertensionUric Acid, Fructose and Hypertension
Uric Acid, Fructose and Hypertension
 
Hyponatremia
HyponatremiaHyponatremia
Hyponatremia
 
Diabetic Nephropathy 2009
Diabetic Nephropathy 2009Diabetic Nephropathy 2009
Diabetic Nephropathy 2009
 
Osmolar Gap
Osmolar GapOsmolar Gap
Osmolar Gap
 
Sodium dreadnaught
Sodium dreadnaughtSodium dreadnaught
Sodium dreadnaught
 
Electrolyte Free Water Clearance
Electrolyte Free Water ClearanceElectrolyte Free Water Clearance
Electrolyte Free Water Clearance
 
The Two Faces of Geriatric Kidney Disease
The Two Faces of Geriatric Kidney DiseaseThe Two Faces of Geriatric Kidney Disease
The Two Faces of Geriatric Kidney Disease
 
Whats New In Potassium
Whats New In PotassiumWhats New In Potassium
Whats New In Potassium
 
Lead Time Bias
Lead Time BiasLead Time Bias
Lead Time Bias
 
Electrolyte Vignette
Electrolyte VignetteElectrolyte Vignette
Electrolyte Vignette
 

KĂŒrzlich hochgeladen

Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore EscortsCall Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escortsvidya singh
 
Call Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls Jaipurparulsinha
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Call Girls in Nagpur High Profile
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...narwatsonia7
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...narwatsonia7
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...astropune
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...narwatsonia7
 
Call Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night Enjoy
Call Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night EnjoyCall Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night Enjoy
Call Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night Enjoybabeytanya
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls AvailableNehru place Escorts
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...chandars293
 
Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...CALL GIRLS
 
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.MiadAlsulami
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
High Profile Call Girls Coimbatore Saanvi☎ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎ 8250192130 Independent Escort Se...narwatsonia7
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Servicevidya singh
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsGfnyt
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableDipal Arora
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 

KĂŒrzlich hochgeladen (20)

Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore EscortsCall Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
Call Girls Horamavu WhatsApp Number 7001035870 Meeting With Bangalore Escorts
 
Call Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls JaipurCall Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls Jaipur
Call Girls Service Jaipur Grishma WhatsApp ❀8445551418 VIP Call Girls Jaipur
 
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
Book Paid Powai Call Girls Mumbai 𖠋 9930245274 𖠋Low Budget Full Independent H...
 
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
Top Rated Bangalore Call Girls Mg Road ⟟ 8250192130 ⟟ Call Me For Genuine Sex...
 
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...Bangalore Call Girls Nelamangala Number 7001035870  Meetin With Bangalore Esc...
Bangalore Call Girls Nelamangala Number 7001035870 Meetin With Bangalore Esc...
 
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
Best Rate (Hyderabad) Call Girls Jahanuma ⟟ 8250192130 ⟟ High Class Call Girl...
 
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
VIP Call Girls Tirunelveli Aaradhya 8250192130 Independent Escort Service Tir...
 
Call Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night Enjoy
Call Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night EnjoyCall Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night Enjoy
Call Girl Number in Panvel MumbaiđŸ“Č 9833363713 💞 Full Night Enjoy
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 âŁïžđŸ’Ż Top Class Girls Available
 
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Varanasi Just Call 9907093804 Top Class Call Girl Service Available
 
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
The Most Attractive Hyderabad Call Girls Kothapet 𖠋 6297143586 𖠋 Will You Mis...
 
Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...
Call Girls Service Surat Samaira â€ïžđŸ‘ 8250192130 👄 Independent Escort Service ...
 
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
 
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Coimbatore Just Call 9907093804 Top Class Call Girl Service Available
 
High Profile Call Girls Coimbatore Saanvi☎ 8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎  8250192130 Independent Escort Se...High Profile Call Girls Coimbatore Saanvi☎  8250192130 Independent Escort Se...
High Profile Call Girls Coimbatore Saanvi☎ 8250192130 Independent Escort Se...
 
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort ServicePremium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
Premium Call Girls Cottonpet Whatsapp 7001035870 Independent Escort Service
 
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual NeedsBangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
Bangalore Call Girl Whatsapp Number 100% Complete Your Sexual Needs
 
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Nagpur Just Call 9907093804 Top Class Call Girl Service Available
 
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service AvailableCall Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
Call Girls Siliguri Just Call 9907093804 Top Class Call Girl Service Available
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 

Gap Acidosis