mkdir -p /home/daytona/workspace/metabolic-acidosis-ppt && ls /home/daytona/work…

~/metabolic-acidosis-ppt/build.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Metabolic Acidosis: Pathophysiology & Management";
pres.author = "Orris Medical";

// ─── COLOUR PALETTE ───────────────────────────────────────────────
const C = {
  navy:      "0D2B55",  // dominant dark
  teal:      "1A7A8A",  // supporting
  accent:    "E8A020",  // warm amber accent
  lightBg:   "EEF4F7",  // slide body background
  white:     "FFFFFF",
  textDark:  "1C2B3A",
  textMid:   "3D5166",
  textLight: "FFFFFF",
  red:       "C0392B",
  green:     "1E8449",
  orange:    "D35400",
  purple:    "6C3483",
  cardBlue:  "1B4F72",
  cardTeal:  "148F77",
  cardPurp:  "7D3C98",
  cardRed:   "A93226",
  cardOrange:"B7770D",
};

// ─── HELPERS ──────────────────────────────────────────────────────
function addSlideHeader(slide, title, subtitle, dark) {
  const bg = dark ? C.navy : C.lightBg;
  slide.background = { color: bg };
  // top accent bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: 0.08,
    fill: { color: C.accent }, line: { color: C.accent }
  });
  // section label pill
  if (subtitle) {
    slide.addShape(pres.ShapeType.rect, {
      x: 0.4, y: 0.15, w: 2.2, h: 0.32,
      fill: { color: C.teal }, line: { color: C.teal },
      rectRadius: 0.06
    });
    slide.addText(subtitle.toUpperCase(), {
      x: 0.4, y: 0.15, w: 2.2, h: 0.32,
      fontSize: 7.5, bold: true, color: C.white,
      align: "center", valign: "middle", margin: 0
    });
  }
  slide.addText(title, {
    x: 0.4, y: subtitle ? 0.52 : 0.2, w: 9.2, h: 0.55,
    fontSize: 22, bold: true,
    color: dark ? C.white : C.navy,
    fontFace: "Calibri"
  });
  // horizontal rule
  slide.addShape(pres.ShapeType.line, {
    x: 0.4, y: subtitle ? 1.08 : 0.82, w: 9.2, h: 0,
    line: { color: C.accent, width: 2 }
  });
}

function addCard(slide, x, y, w, h, color, title, bullets) {
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h,
    fill: { color },
    line: { color },
    shadow: { type: "outer", blur: 4, offset: 2, angle: 45, color: "888888", opacity: 0.3 }
  });
  slide.addText(title, {
    x: x + 0.12, y: y + 0.05, w: w - 0.24, h: 0.32,
    fontSize: 10, bold: true, color: C.white, fontFace: "Calibri", margin: 0
  });
  const items = bullets.map((b, i) => ({
    text: b,
    options: { bullet: { type: "bullet" }, breakLine: i < bullets.length - 1,
               fontSize: 8.5, color: "DDECF5", fontFace: "Calibri" }
  }));
  slide.addText(items, {
    x: x + 0.12, y: y + 0.40, w: w - 0.24, h: h - 0.48,
    valign: "top", margin: 0
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };

  // large decorative rect right side
  s.addShape(pres.ShapeType.rect, {
    x: 7.0, y: 0, w: 3.0, h: 5.625,
    fill: { color: C.teal }, line: { color: C.teal }
  });
  // accent strip
  s.addShape(pres.ShapeType.rect, {
    x: 6.85, y: 0, w: 0.15, h: 5.625,
    fill: { color: C.accent }, line: { color: C.accent }
  });

  s.addText("METABOLIC", {
    x: 0.5, y: 0.55, w: 6.2, h: 0.9,
    fontSize: 48, bold: true, color: C.accent, fontFace: "Calibri", charSpacing: 8
  });
  s.addText("ACIDOSIS", {
    x: 0.5, y: 1.3, w: 6.2, h: 0.9,
    fontSize: 48, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 8
  });
  s.addShape(pres.ShapeType.line, {
    x: 0.5, y: 2.25, w: 5.5, h: 0,
    line: { color: C.accent, width: 3 }
  });
  s.addText("Pathophysiology & Management", {
    x: 0.5, y: 2.4, w: 6.2, h: 0.5,
    fontSize: 18, color: "A8C8D8", fontFace: "Calibri", italic: true
  });
  s.addText([
    { text: "Harrison's Principles of Internal Medicine 22E  •  ", options: { italic: true } },
    { text: "NKF Primer on Kidney Diseases 8E  •  ", options: { italic: true } },
    { text: "Brenner & Rector's The Kidney", options: { italic: true } }
  ], {
    x: 0.5, y: 5.0, w: 6.2, h: 0.45,
    fontSize: 8, color: "8AAABB", fontFace: "Calibri"
  });

  // icons on right panel
  s.addText("pH < 7.35", {
    x: 7.1, y: 1.1, w: 2.7, h: 0.45,
    fontSize: 14, bold: true, color: C.white, align: "center", fontFace: "Calibri"
  });
  s.addText("HCO₃⁻ < 22 mEq/L", {
    x: 7.1, y: 1.7, w: 2.7, h: 0.45,
    fontSize: 12, color: "D5EEF5", align: "center", fontFace: "Calibri"
  });
  s.addText("↓ PaCO₂\n(compensation)", {
    x: 7.1, y: 2.3, w: 2.7, h: 0.6,
    fontSize: 11, color: "A8D4E0", align: "center", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 2 — DEFINITION & OVERVIEW
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Definition & Overview", "INTRODUCTION");

  // Definition box
  s.addShape(pres.ShapeType.rect, {
    x: 0.4, y: 1.2, w: 9.2, h: 0.85,
    fill: { color: C.navy }, line: { color: C.navy }
  });
  s.addText("Metabolic acidosis is a primary acid-base disorder characterised by a reduction in serum bicarbonate [HCO₃⁻], leading to a fall in arterial pH below 7.35.", {
    x: 0.55, y: 1.25, w: 8.9, h: 0.75,
    fontSize: 12, color: C.white, fontFace: "Calibri", italic: true, valign: "middle"
  });

  // 3 feature cards
  const cards = [
    { x: 0.4,  color: C.cardBlue, title: "ABG Hallmarks", pts: ["pH < 7.35", "↓ HCO₃⁻ (primary)", "↓ PaCO₂ (compensation)", "Base excess < −2 mEq/L"] },
    { x: 3.6,  color: C.cardTeal, title: "Compensatory Response", pts: ["Kussmaul breathing", "Hyperventilation within 1 h", "Full compensation in 12–36 h", "Expected PaCO₂ = 1.5×[HCO₃⁻]+8±2"] },
    { x: 6.8,  color: C.cardPurp, title: "Clinical Impact", pts: ["Impaired cardiac contractility", "Vasodilation → hypotension", "Hyperkalaemia", "Altered mental status"] },
  ];
  cards.forEach(c => addCard(s, c.x, 2.15, 3.0, 3.1, c.color, c.title, c.pts));
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 3 — PATHOPHYSIOLOGY
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Pathophysiology", "MECHANISM");

  // Flow diagram boxes
  const boxes = [
    { x: 0.3,  y: 1.2,  label: "↑ Acid Production\nor Ingestion",      color: C.cardRed },
    { x: 2.7,  y: 1.2,  label: "↓ Renal Acid\nExcretion",              color: C.cardOrange },
    { x: 5.1,  y: 1.2,  label: "Excess GI / Renal\nHCO₃⁻ Loss",       color: C.cardBlue },
    { x: 7.5,  y: 1.2,  label: "Exogenous\nToxins",                    color: C.cardPurp },
  ];
  boxes.forEach(b => {
    s.addShape(pres.ShapeType.rect, {
      x: b.x, y: b.y, w: 2.2, h: 0.75,
      fill: { color: b.color }, line: { color: b.color }
    });
    s.addText(b.label, {
      x: b.x, y: b.y, w: 2.2, h: 0.75,
      fontSize: 9.5, bold: true, color: C.white,
      align: "center", valign: "middle", fontFace: "Calibri"
    });
  });

  // Down arrows → HCO3 box
  [0.3, 2.7, 5.1, 7.5].forEach(x => {
    s.addShape(pres.ShapeType.line, {
      x: x + 1.1, y: 1.95, w: 0, h: 0.45,
      line: { color: C.accent, width: 2 }
    });
    // arrowhead (small triangle at bottom)
    s.addText("▼", { x: x + 0.9, y: 2.3, w: 0.4, h: 0.2, fontSize: 9, color: C.accent });
  });

  // Central result box
  s.addShape(pres.ShapeType.rect, {
    x: 1.5, y: 2.55, w: 7.0, h: 0.6,
    fill: { color: C.navy }, line: { color: C.accent, width: 2 }
  });
  s.addText("↓ Serum HCO₃⁻  →  ↓ Blood pH  →  Metabolic Acidosis", {
    x: 1.5, y: 2.55, w: 7.0, h: 0.6,
    fontSize: 13, bold: true, color: C.accent,
    align: "center", valign: "middle", fontFace: "Calibri"
  });

  // Buffering section
  s.addText("Buffering & Compensation", {
    x: 0.4, y: 3.3, w: 5.0, h: 0.35,
    fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri"
  });

  const bufferItems = [
    { text: "Immediate: Extracellular bicarbonate buffer (H⁺ + HCO₃⁻ → H₂CO₃ → CO₂ + H₂O)", options: { bullet: true, breakLine: true, fontSize: 9.5, color: C.textDark } },
    { text: "Minutes: Intracellular proteins and haemoglobin accept H⁺", options: { bullet: true, breakLine: true, fontSize: 9.5, color: C.textDark } },
    { text: "Hours: Respiratory – Kussmaul breathing blows off CO₂; PaCO₂ falls proportionally to ↓HCO₃⁻", options: { bullet: true, breakLine: true, fontSize: 9.5, color: C.textDark } },
    { text: "Days: Renal – Increased NH₄⁺ excretion; regeneration of HCO₃⁻", options: { bullet: true, fontSize: 9.5, color: C.textDark } },
  ];
  s.addText(bufferItems, {
    x: 0.4, y: 3.7, w: 9.2, h: 1.65,
    valign: "top", fontFace: "Calibri"
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 4 — ANION GAP CLASSIFICATION
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Anion Gap Classification", "DIAGNOSIS");

  // AG formula box
  s.addShape(pres.ShapeType.rect, {
    x: 0.4, y: 1.2, w: 9.2, h: 0.6,
    fill: { color: C.teal }, line: { color: C.teal }
  });
  s.addText("Anion Gap (AG) = Na⁺ − (Cl⁻ + HCO₃⁻)    |    Normal = 8–12 mEq/L    |    Correct for albumin: +2.5 mEq/L per 1 g/dL ↓ albumin", {
    x: 0.4, y: 1.2, w: 9.2, h: 0.6,
    fontSize: 10.5, bold: true, color: C.white,
    align: "center", valign: "middle", fontFace: "Calibri"
  });

  // Two columns
  // High AG column
  s.addShape(pres.ShapeType.rect, {
    x: 0.3, y: 1.95, w: 4.4, h: 0.45,
    fill: { color: C.cardRed }, line: { color: C.cardRed }
  });
  s.addText("HIGH Anion Gap Acidosis  (AG > 12)", {
    x: 0.3, y: 1.95, w: 4.4, h: 0.45,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", fontFace: "Calibri"
  });

  const highAG = [
    ["Lactic Acidosis", "Sepsis, shock, cardiac failure, ischaemia, drugs (metformin), cancer"],
    ["Diabetic Ketoacidosis", "Insulin deficiency → ↑ β-hydroxybutyrate + acetoacetate"],
    ["Alcoholic Ketoacidosis", "Alcohol binge + starvation; ↑ β-hydroxybutyrate"],
    ["Starvation Ketoacidosis", "Prolonged fasting; mild-moderate elevation"],
    ["Renal Failure", "Accumulation of sulphate, phosphate, organic anions"],
    ["Toxins", "Ethylene glycol, methanol, salicylates, propylene glycol"],
  ];
  highAG.forEach(([title, desc], i) => {
    const y = 2.48 + i * 0.45;
    s.addShape(pres.ShapeType.rect, {
      x: 0.3, y, w: 4.4, h: 0.42,
      fill: { color: i % 2 === 0 ? "FDECEA" : "FAD7D3" },
      line: { color: "E5A09C" }
    });
    s.addText([
      { text: title + ": ", options: { bold: true, fontSize: 8.5, color: C.cardRed } },
      { text: desc, options: { fontSize: 8, color: C.textDark } }
    ], { x: 0.42, y: y + 0.03, w: 4.16, h: 0.36, valign: "middle", fontFace: "Calibri" });
  });

  // Normal AG column
  s.addShape(pres.ShapeType.rect, {
    x: 5.1, y: 1.95, w: 4.5, h: 0.45,
    fill: { color: C.cardBlue }, line: { color: C.cardBlue }
  });
  s.addText("NORMAL Anion Gap (Hyperchloraemic) Acidosis", {
    x: 5.1, y: 1.95, w: 4.5, h: 0.45,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", fontFace: "Calibri"
  });

  const normalAG = [
    ["Diarrhoea", "Most common GI cause; HCO₃⁻ loss in stool; UAG negative"],
    ["GI Fistulae", "Biliary, pancreatic, or small bowel fistulae"],
    ["Proximal RTA (Type 2)", "↓ HCO₃⁻ reabsorption; Fanconi syndrome; UAG positive"],
    ["Distal RTA (Type 1)", "↓ H⁺ secretion in collecting duct; hypokalaemia; UAG positive"],
    ["Hyperkalemic RTA (Type 4)", "Hypoaldosteronism; impaired NH₄⁺ excretion; hyperkalaemia"],
    ["Exogenous acids / Saline", "NH₄Cl, HCl, large-volume normal saline infusion"],
  ];
  normalAG.forEach(([title, desc], i) => {
    const y = 2.48 + i * 0.45;
    s.addShape(pres.ShapeType.rect, {
      x: 5.1, y, w: 4.5, h: 0.42,
      fill: { color: i % 2 === 0 ? "EAF4FB" : "D6EAF8" },
      line: { color: "9DC3E6" }
    });
    s.addText([
      { text: title + ": ", options: { bold: true, fontSize: 8.5, color: C.cardBlue } },
      { text: desc, options: { fontSize: 8, color: C.textDark } }
    ], { x: 5.22, y: y + 0.03, w: 4.26, h: 0.36, valign: "middle", fontFace: "Calibri" });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 5 — CLINICAL FEATURES
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Clinical Features", "PRESENTATION");

  const systems = [
    { sys: "Respiratory", color: C.teal,      icon: "🫁", pts: ["Kussmaul breathing (deep, rapid, sighing)", "Compensatory hyperventilation", "Dyspnoea, air hunger", "Respiratory muscle fatigue in severe acidosis"] },
    { sys: "Cardiovascular", color: C.cardRed, icon: "❤️", pts: ["↓ Cardiac contractility", "Peripheral vasodilation", "Hypotension, impaired perfusion", "Arrhythmias, V-fib risk (pH < 7.1)"] },
    { sys: "Neurological", color: C.cardPurp,  icon: "🧠", pts: ["Headache, confusion", "Lethargy, stupor → coma", "↑ Intracranial pressure (severe)", "Impaired cerebral function"] },
    { sys: "Metabolic / Electrolyte", color: C.cardOrange, icon: "⚗️", pts: ["Hyperkalaemia (H⁺/K⁺ exchange)", "Hyponatraemia (dilutional)", "Bone demineralisation (chronic)", "Muscle catabolism, growth retardation"] },
    { sys: "Renal", color: C.cardBlue, icon: "🫘", pts: ["↑ NH₄⁺ production & excretion", "Nephrolithiasis (chronic RTA)", "Nephrocalcinosis", "Progressive CKD acceleration"] },
    { sys: "GI / Other", color: C.navy, icon: "🔬", pts: ["Nausea, vomiting", "Abdominal pain (DKA)", "Fruity breath (ketosis)", "Oxalate crystals in urine (ethylene glycol)"] },
  ];

  systems.forEach((sys, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.3 + col * 3.25;
    const y = 1.2 + row * 2.1;
    s.addShape(pres.ShapeType.rect, {
      x, y, w: 3.1, h: 1.95,
      fill: { color: sys.color },
      line: { color: sys.color }
    });
    s.addText(sys.sys, {
      x: x + 0.1, y: y + 0.05, w: 2.9, h: 0.35,
      fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri"
    });
    const bullets = sys.pts.map((p, idx) => ({
      text: p,
      options: { bullet: true, breakLine: idx < sys.pts.length - 1, fontSize: 8.2, color: "D5EEF5" }
    }));
    s.addText(bullets, {
      x: x + 0.1, y: y + 0.42, w: 2.9, h: 1.45,
      valign: "top", fontFace: "Calibri"
    });
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 6 — DIAGNOSIS: STEPWISE APPROACH
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Stepwise Diagnostic Approach", "DIAGNOSIS");

  const steps = [
    { n: "1", label: "Obtain ABG + electrolytes simultaneously", detail: "Measure pH, PaCO₂, HCO₃⁻ from ABG; compare calculated vs. measured HCO₃⁻ (should agree ±2 mEq/L)" },
    { n: "2", label: "Confirm metabolic acidosis", detail: "pH < 7.35 with ↓ HCO₃⁻; primary disturbance = metabolic if HCO₃⁻ is the driver" },
    { n: "3", label: "Calculate Anion Gap", detail: "AG = Na⁺ − (Cl⁻ + HCO₃⁻); correct for albumin (+2.5 per 1 g/dL drop below 4 g/dL)" },
    { n: "4", label: "High AG → MUDPILES / Normal AG → UAG", detail: "High AG: MUDPILES. Normal AG: Urine AG = (Na⁺+K⁺)u − Cl⁻u; negative = GI loss; positive = RTA" },
    { n: "5", label: "Assess respiratory compensation", detail: "Expected PaCO₂ = (1.5 × HCO₃⁻) + 8 ±2  (Winter's formula); deviation = mixed disorder" },
    { n: "6", label: "Delta-Delta ratio (high-AG only)", detail: "ΔAG / ΔHCO₃⁻ ratio: 1–2 = pure high-AG; < 1 = mixed high + normal AG; > 2 = mixed high-AG + metabolic alkalosis" },
    { n: "7", label: "Identify underlying cause", detail: "History, exam, BUN/creatinine, glucose, lactate, ketones, osmol gap, drug/toxin screen, urine studies" },
  ];

  steps.forEach((st, i) => {
    const y = 1.15 + i * 0.61;
    // number circle
    s.addShape(pres.ShapeType.ellipse, {
      x: 0.3, y: y + 0.05, w: 0.42, h: 0.42,
      fill: { color: i < 3 ? C.teal : i < 5 ? C.accent : C.navy },
      line: { color: "FFFFFF" }
    });
    s.addText(st.n, {
      x: 0.3, y: y + 0.05, w: 0.42, h: 0.42,
      fontSize: 11, bold: true, color: C.white,
      align: "center", valign: "middle", fontFace: "Calibri", margin: 0
    });
    // label
    s.addText(st.label, {
      x: 0.85, y: y + 0.04, w: 3.5, h: 0.25,
      fontSize: 9.5, bold: true, color: C.navy, fontFace: "Calibri"
    });
    // detail
    s.addText(st.detail, {
      x: 0.85, y: y + 0.29, w: 8.7, h: 0.28,
      fontSize: 8, color: C.textMid, fontFace: "Calibri"
    });
    // divider
    if (i < steps.length - 1) {
      s.addShape(pres.ShapeType.line, {
        x: 0.85, y: y + 0.59, w: 8.7, h: 0,
        line: { color: "CCDDEE", width: 0.5 }
      });
    }
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 7 — MANAGEMENT: OVERVIEW
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Management Overview", "TREATMENT");

  // 2-column layout
  // Left: General Principles
  s.addShape(pres.ShapeType.rect, {
    x: 0.3, y: 1.2, w: 4.6, h: 0.42,
    fill: { color: C.navy }, line: { color: C.navy }
  });
  s.addText("GENERAL PRINCIPLES", {
    x: 0.3, y: 1.2, w: 4.6, h: 0.42,
    fontSize: 11, bold: true, color: C.accent,
    align: "center", valign: "middle", fontFace: "Calibri"
  });
  const genPrinciples = [
    "Identify and TREAT the underlying cause (primary goal)",
    "Assess severity: pH, HCO₃⁻, clinical features",
    "Monitor ABG, electrolytes, lactate, urine output closely",
    "Correct associated electrolyte disorders (especially K⁺)",
    "Alkali therapy: Reserved for specific indications (see next slides)",
    "Haemodialysis if refractory or toxin-induced",
    "ICU/HDU care for pH < 7.20 or haemodynamic instability",
  ];
  const genItems = genPrinciples.map((p, i) => ({
    text: p,
    options: { bullet: { type: "bullet" }, breakLine: i < genPrinciples.length - 1, fontSize: 9, color: C.textDark }
  }));
  s.addText(genItems, {
    x: 0.3, y: 1.68, w: 4.6, h: 3.7,
    valign: "top", fontFace: "Calibri",
    fill: { color: "F0F6FA" }, line: { color: "C0D8E8" }
  });

  // Right: NaHCO3 guidance
  s.addShape(pres.ShapeType.rect, {
    x: 5.1, y: 1.2, w: 4.5, h: 0.42,
    fill: { color: C.teal }, line: { color: C.teal }
  });
  s.addText("SODIUM BICARBONATE THERAPY", {
    x: 5.1, y: 1.2, w: 4.5, h: 0.42,
    fontSize: 11, bold: true, color: C.white,
    align: "center", valign: "middle", fontFace: "Calibri"
  });

  const bicarb = [
    { title: "Indications", color: C.cardRed, pts: ["Non-AG (hyperchloraemic) acidosis", "Uremic acidosis (non-metabolisable anions)", "Severe acidaemia pH < 7.10–7.20 (individualise)", "DKA only if pH < 7.00 with shock"] },
    { title: "Contraindications / Caution", color: C.cardOrange, pts: ["Lactic acidosis from tissue hypoxia (may worsen)", "DKA (not routine; risk of hypokalaemia, cerebral oedema)", "Respiratory compromise (CO₂ load)", "Overcorrection → paradoxical CNS acidosis"] },
    { title: "Dosing Guidance", color: C.cardBlue, pts: ["Target: ↑ HCO₃⁻ to 10–12 mmol/L (DKA) or 22 mmol/L (CKD)", "50 mEq NaHCO₃ in 300 mL saline over 30–45 min IV (DKA)", "PO: NaHCO₃ tablets 650 mg (7.8 mEq) or Shohl's solution", "Monitor K⁺ carefully during correction"] },
  ];
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    });
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      text: p,
      options: { bullet: true, breakLine: i < b.pts.length - 1, fontSize: 8, color: C.textDark }
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    });
    yb += b.pts.length * 0.3 + 0.1;
  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 8 — MANAGEMENT BY CAUSE
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "Cause-Specific Management", "TREATMENT");

  const causes = [
    {
      title: "Lactic Acidosis (Type A)",
      color: C.cardRed,
      x: 0.3, y: 1.2, w: 3.0,
      pts: ["Restore tissue perfusion urgently", "IV fluids, vasopressors for septic shock", "Treat infection (antibiotics)", "Oxygen / mechanical ventilation", "Avoid NaHCO₃ (may worsen intracellular acidosis)", "Consider renal replacement therapy if severe"]
    },
    {
      title: "Diabetic Ketoacidosis",
      color: C.cardOrange,
      x: 3.55, y: 1.2, w: 3.0,
      pts: ["IV fluids (normal saline initially)", "Insulin infusion 0.1 U/kg/h", "Potassium replacement (K⁺ < 3.5 → hold insulin)", "NaHCO₃ only if pH < 7.00 with shock", "Target HCO₃⁻ 10–12 mmol/L (not normal)", "Monitor glucose, K⁺, pH hourly"]
    },
    {
      title: "Renal Tubular Acidosis",
      color: C.cardBlue,
      x: 6.8, y: 1.2, w: 2.9,
      pts: ["Type 1 (distal): NaHCO₃ 1–3 mEq/kg/day; K⁺ citrate", "Type 2 (proximal): Large alkali doses; K⁺ supplement", "Type 4: Fludrocortisone (if hypoaldosteronism)", "Remove offending drugs (carbonic anhydrase inhibitors)"]
    },
    {
      title: "CKD / Uraemic Acidosis",
      color: C.cardTeal,
      x: 0.3, y: 3.6, w: 3.0,
      pts: ["Oral NaHCO₃ 1–1.5 mEq/kg/day", "Target HCO₃⁻ > 22 mmol/L", "Fruits & vegetables (citrate) as alternative", "Slows CKD progression", "Dialysis for end-stage / refractory cases"]
    },
    {
      title: "Toxic Ingestions",
      color: C.cardPurp,
      x: 3.55, y: 3.6, w: 3.0,
      pts: ["Ethylene glycol / Methanol: Fomepizole (4-MP) 15 mg/kg IV", "Correct osmol gap; urgent haemodialysis", "Salicylates: Urinary alkalinisation, HD if severe", "Activated charcoal if early presentation"]
    },
    {
      title: "GI Losses (Diarrhoea)",
      color: C.navy,
      x: 6.8, y: 3.6, w: 2.9,
      pts: ["IV/PO fluid replacement", "Treat underlying GI cause", "Correct associated hypokalaemia", "Oral rehydration salts", "Alkali rarely needed if cause treated"]
    },
  ];

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      valign: "top", fontFace: "Calibri"
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  });
}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 9 — HIGH-AG ACIDOSIS: MUDPILES MNEMONIC
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  addSlideHeader(s, "High AG Acidosis: MUDPILES Mnemonic", "MEMORY AID");
  s.background = { color: "0A1A30" };

  const letters = [
    { L: "M", word: "Methanol", detail: "Causes formate accumulation → optic nerve damage; high osmol gap" },
    { L: "U", word: "Uraemia", detail: "CKD → retained sulphates, phosphates, organic acids" },
    { L: "D", word: "DKA / Alcoholic KA", detail: "β-hydroxybutyrate + acetoacetate; blood glucose + ketones ↑" },
    { L: "P", word: "Propylene glycol / Pyroglutamic acid", detail: "IV lorazepam vehicle (PG); paracetamol/5-oxoproline (PGA)" },
    { L: "I", word: "Iron / INH / Isoniazid", detail: "Mitochondrial toxicity; lactic acidosis; seizures" },
    { L: "L", word: "Lactic acidosis", detail: "Type A (tissue hypoxia) vs Type B (mitochondrial, drugs)" },
    { L: "E", word: "Ethylene glycol", detail: "Oxalate crystals in urine; renal failure; osmol gap" },
    { L: "S", word: "Salicylates", detail: "Mixed HAGMA + respiratory alkalosis; tinnitus" },
  ];

  letters.forEach((item, i) => {
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    const row = Math.floor(i / 2);
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}

// ═══════════════════════════════════════════════════════════════════
// SLIDE 10 — SUMMARY & KEY TAKE-AWAYS
// ═══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.navy };

  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: "100%", h: 0.08,
    fill: { color: C.accent }, line: { color: C.accent }
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    x: 0.5, y: 0.78, w: 9.0, h: 0,
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  const takeaways = [
    { n: "01", text: "Metabolic acidosis = ↓ HCO₃⁻ + ↓ pH, compensated by hyperventilation (↓ PaCO₂)." },
    { n: "02", text: "Always calculate the Anion Gap and correct for albumin; it splits causes into High-AG (MUDPILES) vs Normal-AG (GI loss / RTA)." },
    { n: "03", text: "Winter's formula checks adequacy of respiratory compensation: expected PaCO₂ = 1.5×HCO₃⁻ + 8 ±2." },
    { n: "04", text: "Treat the underlying cause — this is the primary and most effective management strategy." },
    { n: "05", text: "NaHCO₃ is indicated for hyperchloraemic acidosis and uremic acidosis (target HCO₃⁻ ≥ 22); use with caution in lactic acidosis." },
    { n: "06", text: "In DKA, NaHCO₃ only for pH < 7.00 with shock; target HCO₃⁻ 10–12 mmol/L — never overcorrect." },
    { n: "07", text: "Toxin ingestion: fomepizole for methanol/ethylene glycol + urgent haemodialysis; urinary alkalinisation for salicylates." },
    { n: "08", text: "Chronic metabolic acidosis in CKD accelerates bone loss and CKD progression; treat with oral alkali to maintain HCO₃⁻ > 22 mmol/L." },
  ];

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  s.addText("Sources: Harrison's Principles of Internal Medicine 22E (2025)  •  NKF Primer on Kidney Diseases 8E  •  Brenner & Rector's The Kidney", {
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// ─── WRITE FILE ───────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/metabolic-acidosis-ppt/Metabolic_Acidosis.pptx" })
  .then(() => console.log("SUCCESS: Metabolic_Acidosis.pptx created"))
  .catch(e => { console.error("ERROR:", e); process.exit(1); });

cd /home/daytona/workspace/metabolic-acidosis-ppt && node build.js 2>&1

ls -lh /home/daytona/workspace/metabolic-acidosis-ppt/Metabolic_Acidosis.pptx