J Trauma 2004; 57:993. 11. b. • Summary : An acute, uncompensated respiratory acidosis leading to acidemia. Respiratory alkalosis, Fully compensated. Diuretics or water pills. Electrolyte imbalances, which affect levels of sodium, chloride, potassium and other electrolytes. The objective of present study was to ascertain the acid base status of patient of acute STEMI at the time of … A normal pH value is between 7.35 and 7.45. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids. 30 seconds . Baking soda. Partially compensated metabolic acidosis pH = 7.58 PaCO2 = 22 HCO3- = 20 Partially compensated respiratory alkalosis pH 7.50 PaCO2 41 HCO3- 33 Metabolic acidosis can be caused by acid accumulation due to increased acid production or acid ingestion; decreased acid excretion; or GI or renal bicarbonate (HCO 3 −) loss. QUESTION 5 Interpret the acid-base balance for the following values. To be more precise, a pH of 7.35 to 7.39 “leans” toward acidosis, while a pH of 7.41 to 7.45 “leans” toward alkalosis. of carbon dioxide (CO 2) in the body. Respiratory Alkalosis, Partially Compensated. b. pH decreased and HCO3 above normal, then it is partially compensated respiratory acidosis. Complete compensation would require a fall in the PCO 2 of 17 mmHg (2.3 kPa) to 23 mmHg (3.1 kPa) Both may require medical intervention and can be life-threatening. So, now let’s draw our diagram with the “lean” taken into consideration. A normal pH value is between 7.35 and 7.45. Topics: cyanotic congenital heart disease, metabolic acidosis. In this manner, what are normal ABG levels? It is the acidosis that leads to hyperkalaemia. When the blood is acidotic, metabolic or respiratory, to maintain a normal pH, acid balance, the bo... • Metabolic acidosis is more severe than respiratory acidosis. Uncompensated metabolic acidosis: an underrecognized risk factor for subsequent intubation requirement Inability to mount an adequate hyperventilatory response to metabolic acidosis is … Albert MS, Dell RB, Winters RW. The pH is less than 7.40 showing a shift towards an acidotic state. The HCO3 is also acidotic showing this is a metabolic issue. In a compensated state, a patient with a metabolic acidosis should be … Acute metabolic acidosis (defined temporally as lasting minutes to a few days) has traditionally been divided into two major categories based on the level of the serum anion gap: non-anion gap and high anion gap metabolic acidosis [].As implied, with the former acid–base disorder, the anion gap is within normal limits, whereas with the latter disorder it is increased. Pdi at all frequencies > 10 Hz was significantly reduced (P < 0.05). PaCO2 is 24. … Given the history of diabetes and ankle swelling, renal failure is a unifying diagnosis with pulmonary oedema contributing to a respiratory acidosis whilst the failure to clear acids causes a metabolic acidosis. Look at pH – < 7.40 – Acidosis; > 7.40 – Alkalosis. Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. All Practice Tests for the CCRN are now available as downloadable PDFs. When metabolic acidosis is severe and can no longer be compensated for adequately … Bicarbonate >28 mM with a normal anion gap indicates a pure metabolic alkalosis. If playback doesn't begin shortly, try restarting your device. ... Also called metabolic acidosis. High anion gap acidoses are most often due to ketoacidosis, lactic acidosis , chronic kidney disease, or certain toxic ingestions. The calculator also determines whether the state is compensated or uncompensated. The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. Unable to burn glucose, the patient is producing ketones as they metabolize fat. Solution: Use Table 2. pH = 7.6 and K = 3.0 both indicate an alkalosis condition. A fruity, acetone smell to the … Although ventilatory defects can cause significant decreases in the blood pH, renal compensatory mechanisms can largely correct the pH over several days. Step 1: Evaluate the pH ... pH down, PaCO2 up). For a general review of acid-base regulation, see Metabolic Acidosis. Let’s do another. It means that the compensatory mechanism tried but failed to bring the pH to normal. uncompensated metabolic acidosis Because the blood pH is acidic with lower than normal CO2 levels, the condition is an uncompensated metabolic acidosis. Example 2-7 would similarly represent an uncompensated metabolic alkalosis. C. Metabolic Acidosis, Uncompensated. … Metabolic acidosis is a type of acidosis that’s usually caused by health conditions that affect the kidneys, heart, digestion, or metabolism. 2. Respiratory Alkalosis, Partially Compensated. Respiratory Alkalosis, Uncompensated. A non-compensated or uncompensated abnormality usually represents an acute change occurring in the body. Dehydration. Next: Chloride-Responsive Alkalosis. Overview; An uncompensated metabolic acidosis is characterized by a blood pH far below 7.35, decreased blood bicarbonate, and a largely normal Pa CO 2.A respiratory-compensated … Uncompensated Metabolic Alkalosis. Metabolic Acidosis, Uncompensated; Metabolic Acidosis, Partially Compensated; Match the acid-base status of the following blood samples to the disorders in the drop down list. The PaCO2 level tells you how much carbon dioxide there is in the blood, and the HCO3 level tells you how much bicarbonate is in the blood. The PaCO2 is markedly elevated, and the HCO3 is normal. c. pH increased, then uncompensated metabolic acidosis (ii) If the PaCO2 is higher than normal, then: a. pH decreased and HCO3 is normal, then it is uncompensated respiratory acidosis. The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. Complete Compensated, metabolic acidosis. The chronic, uncompensated metabolic acidosis and hypoxemia suggested that (1) anaerobic tissue metabolism is significant, and (2) renal function may be compromised, in children with severe cyanotic congenital heart disease. Uncompensated metabolic alkalosis Uncompensated metabolic acidosis Compensated metabolic alkalosis Which body systems will attempt to keep the body in homeostasis if acid … Any blood pH below 7.35 (7.34, 7.33, 7.32, and so on…) is ACIDOSIS. Basic Steps for ABG Interpretation. The PaCO2 level tells you how much carbon dioxide there is in the blood, and the HCO3 level tells you how much bicarbonate is in the blood. In 13 dogs with an arterial pH (pH(a)) of 7.38 and arterial Pco 2 (Pa(co 2)) of 36.5 Torr, metabolic acidosis was produced by infusion of HCl until pH(a) equaled 6.98 and Pa(co 2) equaled 36.4 Torr. Baking soda. It's most often caused by excessive vomiting. Metabolic acidosis is a clinical disturbance defined by a pH less than 7.35 and a low HCO3 level. List the condition - acidosis or alkalosis, metabolic or respiratory, compensated or uncompensated. Uncompensated Metabolic Acidosis is the initial stage that can occur when the kidneys are no longer able to maintain the normal blood pH, but the lungs have not yet been … Acidosis refers to an excess of acid in the blood that causes the pH to fall below 7.35, and alkalosis refers to an excess of base in the blood that causes the pH to rise above 7.45. A patient with a suspect pure metabolic acidosis. The ventilation should be set to mimic the compensatory hyperventilation to keep the pCO 2 low. An uncompensated metabolic alkalosis can be very risky for the health of a person. Certain laxatives. Isn't getting rid of enough acid. Acidosis is a serious metabolic imbalance in which there is an excess of acidic molecules in the body. Metabolic acidosis, such as in diabetic ketoacidosis, may lead to deep, rapid breathing, called “Kussmaul breathing”, a part of the body’s effort t... c. Explain the other lab results using the primary cause and equilibrium principles. bicarbonate ions). List the condition - acidosis or alkalosis, metabolic or respiratory, compensated or uncompensated. Background: Metabolic acidosis is known to occur in the early stages of an acute myocardial infarction but it is rarely severe except in the presence of profound cardiogenic shock; nevertheless, it could contribute to the development of dysrhythmias. Metabolic acidosis can be caused by acid accumulation due to increased acid production or acid ingestion; decreased acid excretion; or GI or renal bicarbonate (HCO 3 −) loss. Due to its sudden nature, the causes of acute respiratory acidosis are more clear-cut and perhaps, shocking. 12. Prepare your Tic Tac Toe layout. A patient with a mixed acidosis to determine level of compensation. The nurse on duty notes that the nasogastric tube (NGT) is draining a large amount (900 cc in 2 hours) of coffee ground secretions. The electrocardiogram (ECG) monitor displays tachycardia, with a heart rate of 120 beats/minute. If a patient with a severe metabolic acidosis requires intubation and controlled ventilation in hospital, the acidosis can markedly worsen unless the hyperventilation is maintained. ... Uncompensated. Metabolic Acidosis vs Respiratory Acidosis. The basic step for interpreting arterial blood gas results include: Step 1 – Obtain and Run the ABG Sample. Decrease in ionized Ca 2+, just like in metabolic alkalosis. Summary Hypokalemic paralysis represents a medical emergency requiring both rapid diagnosis and treatment. Table 1 lists some other causes of metabolic acidosis. Metabolic Acidosis, Uncompensated; Metabolic Acidosis, Partially Compensated; Match the acid-base status of the following blood samples to the disorders in the drop down list. Given the history of diabetes and ankle swelling, renal failure is a unifying diagnosis with pulmonary oedema contributing to a respiratory acidosis whilst the failure to clear acids causes a metabolic acidosis. uncompensated acidosis synonyms, uncompensated acidosis pronunciation, uncompensated acidosis translation, English dictionary definition of uncompensated acidosis. Metabolic acidosis has three main root causes: increased acid production, … If pH indicates acidosis,then look at paCO 2 and HCO 3- o In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore the balance. A combined respiratory acidosis / metabolic alkalosis will result in elevated PaCO 2 and serum bicarbonate. 2. compensated acidosis: [ as″ĭ-do´sis ] 1. the accumulation of acid and hydrogen ions or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, resulting in a decrease in pH. Respiratory Acidosis, Uncompensated; Metabolic Acidosis, Partially, Compensated; Carl, an elementary student, was rushed to the hospital due to vomiting and a decreased level of consciousness. Answer: CO2 ⬆, pH ⬇= Respiratory acidosis, uncompensated: this is a respiratory problem and the pH is abnormal (acidotic)…the metabolic system (HCO3) is normal and is not at this time trying … Which process is the primary disorder (e.g. In general, with a pure or uncompensated metabolic acidosis, every 10 mEq/L fall in … 13. Diuretics or water pills. As CO2 is the strongest driver of respiration, it generally will not allow hypoventilation as compensation for metabolic alkalosis. ... Metabolic acidosis causes loss of appetite, jaundice, rapid heart rate, and rapid, shallow breathing. 2. ... Metabolic acidosis causes loss of appetite, jaundice, rapid heart rate, and rapid, shallow breathing. Metabolic Alkalosis, Partially Compensated. pH =7.1 = acidosis, uncompensated. Only injury severity and ability to compensate for metabolic acidosis were independent predictors of intubation. Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. … Metabolic alkalosis is a type of alkalosis that occurs when your blood becomes overly alkaline. Create a Profile. The slower response/compensation to acidosis is the renal response – urinary excretion or retention of acids (eg. Metabolic Alkalosis, Partially Compensated. This ABG profile shows uncompensated metabolic acidosis. A normal PaCO2 is between 35-45 miliLiters mercury, and a normal HCO3 is between 22-26 miliEquivalents per liter. uncompensated metabolic acidosis. Metabolic Acidosis, Partially Compensated, Mr. Wales, who underwent post-abdominal surgery, has a nasogastric tube. Correct! This indicates uncompensated respiratory acidosis. Signs of high metabolism * First of all, people with fast metabolism have fast gastrointestinal motility and gastric emptying speed, food is digest... For a patient with metabolic acidosis it can be useful to calculate the anion gap because this can give some indication of the underlying cause of the acid-base imbalance. Step 3 – Determine if the Issue is Respiratory or Metabolic. Step 1 – pH 7.32 is low, CO2 55 is high, bicarb 29 is high. (PaCO2 values are in mm Hg and bicarbonate values in mmol/l). This content is only available via PDF. Metabolic acidosis can lead to … For pH, the normal range is 7.35 to 7.45. Metabolic acidosis is a condition in which an increased number of body cells have a lower than normal blood pH, which means that they have a greate... Decreased standard (and actual) serum bicarbonate. Treatment of uncompensated metabolic acidosis is focused upon correcting the underlying problem. Ann Intern Med 1967; 66:312. https://www.leveluprn.com/blogs/abg-interpretation/6-metabolic-acidosis Correct! Quantitative displacement of acid-base equilibrium in metabolic acidosis. uncompensated acidosis: an acidosis in which the pH of body fluids is subnormal, because restoration of normal acid-base balance is not possible or has not yet been achieved. Sign in. Because our pH is “leaning” toward acidosis, we have a … Tags: Question 15 . Uncompensated, Respiratory Acidosis Wrong! Treatment of uncompensated metabolic acidosis is focused upon correcting the underlying problem. Already signed up? Metabolic acidosis. We investigated the effects of metabolic acidosis and compensated metabolic acidosis on force of contraction of the diaphragm in anesthetized dogs. References. SURVEY . With overproduction, the body makes too much acid. 4. compensated metabolic acidosis. High anion gap acidoses are most often due to ketoacidosis, lactic acidosis , chronic kidney disease, or certain toxic ingestions. Both may require medical intervention and can be life-threatening. Now, answer these questions and see how … On the flip side, if the pH was not normal but the HCO3 was normal, it would be uncompensated. J Trauma 2004; 57:993. Other value within normal range. A. Compensated Metabolic alkalosis B. Uncompensated Metabolic acidosis C. Compensated Respiratory acidosis D. Uncompensated Respiratory alkalosis Answer: C { 145 } ض أ ر َ أ لْا ي ف ُ ث ُ ك أ … The anion gap helps determine the cause of the metabolic acidosis. Metabolic acidosis happens when the chemical balance of acids and bases in your blood gets thrown off. Respiratory acidosis refers to high levels of acid in the blood due to increased levels. The metabolic acidosis seen in our patients with septic shock is a complex disorder, primarily resulting from hyperchloremia and UA ( Table 3 ). Videos (1) Metabolic acidosis is primary reduction in bicarbonate (HCO 3− ), typically with compensatory reduction in carbon dioxide partial pressure (P co2 ); pH may be markedly low or … Compensated metabolic alkalosis 31 Case Scenario A patient has had an NG tube to intermittent suction for 4 days following abdominal surgery, her ABGs are: pH 7.51 PaC02 45 HCO3-31 This Imbalance is MOST LIKELY: 1. What are normal HCO3 levels? pH =7.1 = acidosis, uncompensated pCO2 = 42 = metabolic, uncompensated … Wrong! A The pH is below normal range (7.35-7.45), so this is uncompensated acidosis. Uncompensated respiratory acidosis values include a pHbelow 7.35, PACO2 above 45 mm Hg, and HCO3 of 22 to 26 mEq/L. • Metabolic acidosis has more causes than respiratory acidosis. Definition. Metabolic change is acid, i.e., responsible for the acidosis with some respiratory compensation; The metabolic acidosis is 10 mEq/L on the acid side of normal. during metabolic acidosis produced by an HCI (or NH 4Cl) load, and to study the time course for this change. Steroids. In metabolic acidosis and alkalosis, HCO3- is causing the abnormal pH and PaCO2 is the compensating factor. compensated metabolic alkalosis. Heart Kidneys Lungs Spleen Liver. Acidosis is when your blood pH drops below 7.35 and becomes too acidic. Alkalosis is when your blood pH is higher than 7.45 and becomes too alkalin... Correct! Often a compensatory reduction in pCO 2. Renal impairment of HCO 3− excretion must be present to sustain alkalosis. compensated metabolic acidosis: • carbonic acid is excreted by the lung ( in the form of co₂ ) → bicarbonate is retained by the kidney → pco₂ falls → ratio bicarbnate : carbonic acid rise → the ph rise toward normal uncompensated and compensated metabolic acidosis normal uncmp.ma comp.ma. Overview; An uncompensated metabolic acidosis is characterized by a blood pH far below 7.35, decreased blood bicarbonate, and a largely normal Pa CO 2.A respiratory-compensated metabolic acidosis is characterized by a blood pH only slightly below 7.35, a decreased blood bicarbonate, and a decreased Pa CO 2.Beyond these general features of metabolic acidosis, calculation of … Metabolic acidosis is a biochemical abnormality defined by an increase in blood hydrogen ion concentration or a reduction in serum bicarbonate (HCO 3) concentration. Metabolic alkalosis is primary increase in bicarbonate (HCO 3−) with or without compensatory increase in carbon dioxide partial pressure (P co2 ); pH may be high or nearly normal. Let’s start playing Tic Tac Toe and learn to interpret ABGs in a fun and easy way. Uncompensated metabolic alkalosis Uncompensated metabolic acidosis Compensated metabolic alkalosis Which body systems will attempt to keep the body in homeostasis if acid-base imbalance continues for an extended period of time? A bicarbonate of 22-28 mm with a normal anion gap indicates a normal metabolic pH status. 3. Define uncompensated acidosis. It is created by one of three mechanisms: (1) increased production of acids, (2) decreased excretion of acids, or (3) loss of alkali. 5.5.3 Maintain hyperventilation in ventilated patients. Most symptoms are caused by the underlying disease or condition that is causing the Uncompensated and compensated (partial or full) arterial blood gas ABG interpretation. Definition. An inadequate ventilator response to this problem may lead to an imminent respiratory failure. In this Attending Rounds a patient with hypokalemia and metabolic acidosis is presented to emphasize the role of routine laboratory studies in the assessment of such patients so that a correct diagnosis can be made and appropriate … Respiratory Acidosis is a pathophysiological category of acidosis and refers to those acidoses caused by primary disturbances in ventilation. Make sure you memorize the normal values of pH, PaCO2, and HCO3. If chloride-responsive alkalosis occurs with volume depletion, treat the alkalosis with an intravenous infusion of isotonic sodium chloride solution. Metabolic acidosis can lead to acidemia, which is defined as arterial blood pH that is lower than 7.35. Metabolic acidosis, Uncompensated. Wrong! Introduction. Daniel SR, Morita SY, Yu M, Dzierba A. Uncompensated metabolic acidosis: an underrecognized risk factor for subsequent intubation requirement. Non-Gap metabolic acidosis is due to GI loss of bicarbonate (diarrhea) or a … … Hobler KE, Carey LC. Test and monitor urine pH. Q. You are preparing to discharge a client whose calcium level was low but is now just slightly within the normal range (9-10.5 mg/dL). Severe dehydration can cause inadequate cardiac output which means that much of the tissue is inadequately oxygenated. In the absence of oxygen the... The client is hypoventilating and has a respiratory rate of 10 breaths/minute. Mechanical Ventilation Part 3 (Severe Metabolic Acidosis): In patients with severe metabolic acidosis, we have to try and match the patient’s minute ventilation before I intubated them as well as compensate for the apnea time during intubation that potentially causes an increase in CO2 which is a major challenge. Next. The patient controls the rate, inspiratory flow, and tidal volume. Oxyhemoglobin Dissociation Curve: will demonstrate a shift to the right with high CO2 and low pH. Example 2-3 would likewise be termed uncompensated respiratory alkalosis. Equilibrium: CO2 + HOH === H2CO3 === H+ + HCO3-. Arterial Blood Gas Analysis Uncompensated Acid-base Disorders Lesson Content 0% Complete 0/6 Steps Acid-base Disturbances Metabolic Acidosis Metabolic Alkalosis Respiratory … Step 1 – pH 7.29 is low, CO2 of 37 is normal, bicarb of 16 is low. bicarbonate: 24 meq/l 15 meq/l 15 meq/l Trusted Source. Respiratory acidosis. [ 1] Metabolic acidosis should be considered a sign of an underlying disease process. Which of the following ventilator modes applies positive pressure during the patient’s spontaneous breaths? Common causes include prolonged vomiting, hypovolemia, diuretic use, and hypokalemia. The pCO2 = 40 value is normal and therefore indicates a metabolic condition. Step 2 – Determine if the pH is Alkalosis or Acidosis. Results to be reported indicate that hy perkalemia occurred during acute metabolic acido sis. This can occur as a result of acid overproduction, impaired acid transport, acid underexcretion, or any combination. Abstract. The most common cause of metabolic acidosis is the presence of organic acids or excessive ketones in the blood. ... Uncompensated Abnormal pH. Steroids. Uncompensated Respiratory Acidosis: pH > 45 + normal HCO3 (22-26). pH 7.37, PaCO2 32, HCO3 18. Arterial PO 2 (PaO 2) zNormal: 80 – 100 mm Hg breathing room air at sea level in healthy young adults (103- 0.5 x age) zPaO 2 affected by – FIO 2 PEEP Lung function – Age Ventilation Altitude PAO 2 = FIO 2(PB-PH 20) – PaCO 2 x 1.2 PAO 2 = FIO2(700) - PaCO 2 x 1.2 Always interpret PaO If playback doesn't begin shortly, try restarting your device. ภาวะ Metabolic acidosis คือภาวะเลือดเป็นกรดจากการมีไบคาร์บอเนต (HCO 3) ในเลือด < 22 mEq/L หรือ mmol/L ซึ่งมีสาเหตุมาจาก 2 กลไก คือ. Respiratory change is alkaline – NOT therefore explaining the acidosis. 3. primary respiratory acidosis with metabolic compensation versus primary metabolic alkalosis with respiratory compensation) is dependent on the pH – in an acidotic patient, the acidosis is primary (and the alkalosis is … The results show that client Z has respiratory alkalosis since there is an increase in the pH value and a decrease in PaCO2 which are both basic. Uncompensated respiratory acidosis occurs when respiratory acidosis is present, with pH acidic (under 7.35) and PaCO₂ acidic (over 45) mmHg; but the metabolic system does … Patients with inadequate compensation were 4.2 times more likely to require … a. The Henderson–Hasselbalch method defines metabolic acidosis by the presence of an acid–base imbalance associated with a plasma bicarbonate concentration below 20 … Metabolic acidosis is a clinical disturbance characterized by an increase in plasma acidity. Define uncompensated alkalosis. Based on the given ABG values, pH is 7.34. Step 4 – Determine if it’s Compensated or Uncompensated. Metabolic acidosis is a clinical disturbance defined by a pH less than 7.35 and a low HCO3 level. Uncompensated metabolic acidosis: an underrecognized risk factor for subsequent intubation requirement. Other risk factors include COPD, Respiratory conditions such as pneumothorax, pneumonia and status asthmaticus. For example, in high anion gap acidosis secondary to accumulation of organic acids, lactate, and ketones, these anions are eventually metabolized to HCO 3-.When the underlying disorder is treated, the serum pH corrects; thus, caution should be exercised in these patients when providing alkali to raise … That depends on the cause. NaHCO3 can be given to temporarily improve the pH. But you need to correct the causative condition—of which there are ma... In general, with a pure or uncompensated metabolic acidosis, every 10 mEq/L fall in bicarbonate (HCO 3) results in an average pH fall of 0.15. This is a picture of a mixed respiratory and metabolic acidosis. Maximum urine acidity is … uncompensated alkalosis synonyms, uncompensated alkalosis pronunciation, uncompensated alkalosis translation, English dictionary definition of uncompensated alkalosis. Correct Answer: B. Metabolic Acidosis, Partially Compensated . Electrolyte … Metabolic acidosis: low ph and low HC03 . Presence or absence of an anion gap (AG) can help to distinguish the underlying etiology. A primary metabolic acidosis is a pathophysiologic state characterized by an arterial pH of less than 7.35 in the absence of an elevated PaCO 2. 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Tetany, laryngospasm, and HCO3 of 22 to 26 meq/l, every 10 meq/l fall …! Lab results using the primary cause & u=a1aHR0cHM6Ly93d3cuYWprZC5vcmcvYXJ0aWNsZS9TMDI3Mi02Mzg2KDg4KTgwMTUzLTcvcGRm & ntb=1 '' > acidosis < /a > Define uncompensated acidosis,... Would likewise be termed uncompensated respiratory acidosis below 7.35, then it is an! Clinically, a patient with a normal pH, the body makes too much.. Most famous example would be acute diabetic ketoacidosis to unconsciousness and syncope in metabolic acidosis can lead acidemia... Uncompensated … < a href= '' https: //www.bing.com/ck/a?! & & p=5c0de37493d92fd62ffb44ae1a2130a6ebf16e0ce18716544384ff3d95f869baJmltdHM9MTY1MzE1NjQwMSZpZ3VpZD1mYWIwYjY0OS03MWU1LTQ1YTctYTFlOC1mY2ZkMmZhZWJmM2MmaW5zaWQ9NTUwOA & ptn=3 & fclid=c1f4d5db-d930-11ec-9223-0f76acb849b5 & &. 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