A.2 Flashcards
what is the first step of evaluating metabolic acidosis?
calculate anion gap
what is the reference range of anion gap?
6-10 is normal
calculating anion gap?
Na - (Cl+HCO3)
what does it tell you if the anion gap is normal i a metabolic acidosis?
its due to primary loss of HCO3 with a Cl- compensation
- bicarbonate loss : RTA, diarhhea (GI loss)
- Iatrogenic acidosis: Cl- administration, saline infusion, dilutional acidosis
drugs causing resp acidosis?
due to CNS depression
Benzos
Opiates
Barbiturates
acute lung diseases causing resp acidosis?
pneumonia
pulmonary edema
acute exacerbation of COPD or asthma
Causes of Metabolic alkalosis?
BLVD PLACE
-Bratters synd
-Laxatives
-Vomiting
-Diarrhea
-Diuretix
-Post hypercapnia
-Licorice
-Alkali Phopphates
-Contraction Alkalosis
-Endocrine (conn/cushing)
Causes of Metabolic Acidosis?
non-anion gap?
RAGES
-RTA
-Ammonia
-G.I. loss
-Endocrine
-Saline
Causes of Metabolic Acidosis?
with anion gap?
GOLDMARKT
-Glycols
-Oxoproline
-Lactate
-D.lactate
-Methanol
-Aspirin
-Renal.f/Rhabdomyelysis
-Ketones
-Tuolene
what causes resp. Acidosis?
Airflow obstruction
-COPD/Asthma
-decrease drive
-increase CO2 production
what causes resp. Alkalosis?
increase in drive
-hypoxemia
-pain
-hepatic encephalopathy
-pregnancy
-Salicylates
metabolic acidosis th?
-treatment of underlying disease
-resp. support
-vit B1 –>cofactor for pyruvate-DH–>ATP production
-RTT (if renal insufficiency)
-NaHCO3 (not always)
-Tromethamine:
->tris-buffer. max daily dose: 5mmol/kg
metabolic acidosis symptoms?
- incr. symp. activity
-decr. inotropy and arterial vasodialation
-kussmaul resp.
-decr. O2-hgb binding
-hyperkalemia
-insulin resistance
-Emesis
-decr. sensorium
-hyperventilation
metabolic alkalosis symptoms?
-hypoventilation
-resp. depression
-NM excitation
-hypokalemia
-seizures
-incr O2-hgb affinity
-decr. coronary bf
-decr. cerebral bf
