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23. CardioPulmonary Renal Exam 3 > 2. Approach to Acid Base > Flashcards

2. Approach to Acid Base Flashcards

1
Q

What is the following equation?

pH= 6.1 + log ( HCO3/ (.03x PCO2) )

A

Henderson-Hasselbalch Equation

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2
Q

When there is an increase in HCO3 or a increase in PCO2, what occurs to blood pH?

A

Inc HCO3 = increase pH

Inc PCO2 = decrease pH

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3
Q

CO2 + H20 —> H2CO3 —> H+ + HCO3

A

Meow

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4
Q

Lungs regulate pH by respiration rate, if increased RR = increased CO2 blown off = ?

A

Increase in pH

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5
Q 
Match the following:
Metabolic acidosis
Metabolic aklalosis
Respiratory acidosis
Respiratory alkalosis
High PCO2
Low serum HCO3
High Serum HCO3
Low PCO2
A

Metabolic acidosis - low HCO3
Metabolic aklalosis - high HCO3
Respiratory acidosis- high pCO2
Respiratory alkalosis- low pCO2

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6
Q

Respiratory alkalosis/acidosis is either chronic or acute, metabolic alkalosis is saline responsive or nonresponsive. What are the 2 types of metabolic acidosis?

A

High anion gap metabolic acidosis (HAGMA)

Normal anion gap metabolic acidosis (NAGMA such as hyperchloermic acidosis)

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7
Q

Compensation formula for metabolic acidosis is winters formular which is PCO2 = ?

A

1.5[HCO3] + 8 +/- 2

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8
Q

COmpensation for metabolic alkalosis is that PCO2 will increase by 0.7 for each 1 increase in?

A

HCO3 from normal (24)

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9
Q

Compensation for respiratory acidosis in ACUTE is HCO3 will increase by 1 for every 10 increase in pCO2 (40nl), chronic is HCO3 increases by 3.5 for every?

A

10 increase in PCO2 (40 nl)

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10
Q

Compensation for respiratory alkalosis in ACUTE is HCO decreases by 2 for every 10 dec in PCO2 and chronic is HCO3 decreases by 5 for every?

A

10mmHg decrease in PCO2 from normal (40)

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11
Q

What is the total amount of acid - base disturbances that can be present at once?

A

3

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12
Q

Anion gap is equal to Na+ - (HCO3 + Cl)

The normal range anion gap is?

A

12+/-2

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13
Q

Anion gap is used to differentiate etiologies of metabolic acidosis such as?

A

High anion gap MA or

Normal anion gap MA (acidosis)

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14
Q

HCl being added to the blood in metabolic acidosis offsets the the loss of HCO3, which is why there is a normal anion gap. What are the 2 most common causes of NAGMA?

A

Renal tubular acidosis and Diarrhea

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15
Q

What can falsely lower anion gap and thus must be corrected?

A

hypoalbuminemia
(for every 1g/dl drop in albumin, AG drops by 2.5)
so if serum albumin is 1.5, normal 3.5…. 2*2.5 = 5 add to anion gap = new anion corrected gap

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16
Q

Serum osmolality is normally 275-290 and is calculated using the equation 2(Na) + (glucose/18) +?

A

BUN/2.8

17
Q

Osmolar gap is serum osmolality minus calculated serum osmolality, normal gap is less than 10, if greater than 10 it suggest WHAT?

A

Alcohol ingestions - HAGMA *** use osmolar gap for screening for alcohol ingestions, ketoacidosis and lactic acidosis

18
Q

What gap calculation is used in patients with HAGMA to determine if there is coexistent NAGMA or metabolic alkalosis present?

A

Delta - Delta Gap

19
Q

For every increase in AG, there should be a equal decrease in HCO3. Delta gap is calculated AG - normal AG (12), and delta HCO3 is normal HCO3 minus?

A

the calculated delta gap = a number

20
Q

if the calculated delta HCO3 is close to the actual HCO3, then no additional acid base disorders. If measured is greater than actual, metabolic alkalosis in addition to HAGMA, if measure is lesser than actual then?

A

NON-gap metabolic acidosis is present in addition to HAGMA

21
Q

When calculating compensation, if it is an appropriate compensation then it is a simple acid base disorder, if the compensation is inappropriate then there is a ?

A

mixed acid - base disorder

22
Q 
NORMAL VALUES
pH: 7.35-7.44
HCO3: 24
PCO2: 40
Anion Gap: 12
Osmolaltity gap: 10
A

Meow

23
Q

GOLDMARK is used for HAGMA DDX, the mneumonic includes….
Glycols (ethylene/propylene)
Oxoproline (pyroglutamic/ acetaminophen toxicity)
L-Lactic acidosis
D-Lactic acidosis (short bowel syndromes)
Mehtanol
Aspirin
Renal failure and?

A

Ketoacidosis (alcoholic/diabetic/starvation)

24
Q

What type of HAGMA acidosis is seen in women who are malnourished or critically ill, with a dx of urinary organic acid screen?

A

pyroglutamic acidosis (5-oxoproline)

25
Q 
DDX of increased osmolar gap is remembered via ME DIE:
Methanol
Ethanol
Diethylene glycol (mannitol)
Isopropyl alcohol (rubbing alch)
and most importantly ****?
A

Ethylene Glycol = ANTIFREEZE

26
Q

Acidosis is associated with hyperkalemia while alkalosis is associated with?

A

Hypokalemia

27
Q

Normal anion gap metabolic acidosis (NAGMA) is most commonly caused by ureteral diversion or fistula such as ileal conduit post cystectomy, diarrhea and?

A

renal tubular acidosis

28
Q

What type of RTA occurs when proimal tubule has decreased capacity to reabsorb HCO3, causing low serum HCO3 and high urine HCO3 loss?

A

Type 2 RTA (see hypokalemia)

29
Q

Urine anion gap is used to differentiate renal from non renal causes of NAGMA and is a clinical marker for what, which indicates appropriate urinary acidification?

A

NH4CL - ammonium chloride excretion

30
Q

Urine anion gap UAG is calculated by UrineNa+ UrineK - Urine Cl, what does it mean if its negative or positive?

A 
Negative = appropriate distal nephron urinary acidification
Positive= inappropriate distal nephron urinary acidification
31
Q

What type of RTA is distal tubule issue, unable to acidify their urine due to decreased H+ ion secretion? (caused by amphotericin)

A

Type 1 (d/t sjogrens syndrome/glue sniffing)
presents with nephrolithiasis/calcinosis
(hypokalemia/low urine pH, UAG positive)

32
Q

What type of RTA is due to a def. in circulating aldosterone or aldosterone resisitance in collecting ducts, causing impaired Na reabsorption by principle cells and leads to hyperkalemia ** (unique, all other RTA cause hypokalemia)?

A

RTA Type 4

UAG positive, pH >5.5

33
Q

MCCs of metabolic alkalosis are hypokalemia, vomiting, nasogastric tube suctioning, diuretics, volume depletion and? these are all factors that stimulate Na reabsorption, secondarily increase H secretion and stimulate HCO reabsorption

A

mineralocorticoid excess

34
Q

Anything that increases respiratory rate or tidal volume can cause?

A

respiratory alkalosis

35
Q

Anything that lowers respiratory rate/tidal volume, increases dead space, or worsens airway obstruction such as inadequate ventilator settings or increases in CO2 production can cause?

A

Respiratory acidosis

36
Q

If there are calcium oxalate crystals present in the urine, what is the expected diagnosis? (increased osmolar gap as well)

A

ETHYLENE GLYCOL

37
Q

If there is a decreased uric acid production in the urine, what can be expected?

A

PCT issues/dysfunction

23. CardioPulmonary Renal Exam 3 (6 decks)

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