Acid-Base

Question 1

what is the acid base mnemonic?

Answer 1

ROME

Respiratory
Opposite

Metabolic
Equal

Question 2

in acid-base disorders, if the opposing value is abnormal and the pH is still abnormal, then _____ ________ has occurred

Answer 2

partial compensation

Question 3

in acid-base disorders, if the opposing value is abnormal and the pH is normal, then _____ ________ has occurred

Answer 3

full compensation

Question 4

what are the symptoms of metabolic acidosis?

Answer 4

“KUSSMAUL”

Kussmaul respirations
Urine changes (pH)
Stupor (mental confusion)
Signs of hyperkalemia (muscle twitching)
Malaise
Abdominal pain
Urine output changes
Low blood pressure

Question 5

what is the initial compensation for metabolic acidosis?

Answer 5

hyperventilation to breath off CO2

Question 6

the difference between the measured cations and anions in the blood

Answer 6

anion gap

Question 7

how to calculate anion gap?

Answer 7

Na - (Cl + HCO3)

Question 8

how to calculate anion gap with normal levels of albumin?

Answer 8

albumin x 3

Question 9

what are 3 endogenous causes of anion gap metabolic acidosis?

Answer 9

DLC

Diabetic Ketoacidosis
Lactic acidosis
Chronic Kidney Disease

Question 10

what are 4 exogenous causes of anion gap metabolic acidosis?

Answer 10

MEAT

Methanol poisoning
Ethylene glycol/antifreeze
ASA overdose
Toluene (paint/glue sniffing)

Question 11

what is the most common cause of non-anion gap metabolic acidosis?

Answer 11

type II renal tubular acidosis (proximal)
unable to reabsorb HCO3

Question 12

what 2 conditions is type I renal tubular acidosis most common in?

Answer 12

Sjogren’s
glue/paint sniffing

Question 13

what is the most common cause of type IV renal tubular acidosis?

Answer 13

diabetes mellitus

Question 14

what causes pancreatitis, panniculitis, polyarthritis, blurred vision and fatigue in metabolic acidosis ?

Answer 14

hyperglycemia

Question 15

what causes CNS abnormalities in metabolic acidosis?

Answer 15

ethylene glycol poisoning

Question 16

what causes retinal edema in metabolic acidosis?

Answer 16

methanol intoxication

Question 17

what cause osteoporosis and fractures in metabolic acidosis?

Answer 17

CKD

Question 18

what is the general treatment for metabolic acidosis if etiology is unknown and pH < 7.1? (4)

Answer 18

IV sodium bicarbonate
dialysis
treat hyperkalemia
consult Nephrology

Question 19

what is the treatment for metabolic acidosis caused by DKA? (4)

Answer 19

IV fluids
IV potassium replacement
IV insulin (if K > 3.3)
IV bicarb (if pH < 6.9)

Question 20

what is the treatment for metabolic acidosis caused by lactic acidosis?

Answer 20

IV Na bicarbonate

Question 21

what is the treatment for metabolic acidosis caused by salicylate overdose? (3)

Answer 21

IV Na bicarbonate
Fluids
Glucose for CNS

Question 22

what is the treatment for metabolic acidosis caused by alcohol overdose? (5)

Answer 22

IV/IM thiamine
saline
K+
phosphate
magnesium

Question 23

what is the treatment for metabolic acidosis caused by methanol intoxication? (2)

Answer 23

fomepizole +/- dialysis

Question 24

what is the treatment for metabolic acidosis caused by diarrhea?

Answer 24

Na bicarbonate

Question 25

what are 2 treatment options for renal tubular acidosis I (distal)?

Answer 25

sodium bicarbonate potassium citrate

Question 26

what are 3 treatment options for renal tubular acidosis II (proximal) that is exogenous?

Answer 26

remove offending agent

Question 27

what are 3 treatments for renal tubular acidosis II (proximal) that is caused by fanconi?

Answer 27

bicarb vit D phosphate replacement

Question 28

what are 3 treatments for renal tubular acidosis IV that is caused by primary adrenal insufficiency?

Answer 28

fludrocortisone saline loop diuretics +/- restrict potassium

Question 29

what are the symptoms of metabolic alkalosis?

Answer 29

**ALKA-LOSIS** **A**pathy **L**oss of potassium (hypokalemia) **K**icking muscle cramps **A**norexia **L**ight-headedness **O**cular disturbance **S**low respirations (hypoventilation) **I**ncreased neuromuscular excitability **S**eizures

Question 30

what is the initial compensation for metabolic alkalosis?

Answer 30

hypoventilation to retain CO2

Question 31

most common cause of metabolic alkalosis and characterized by normotensive, dehydration, and hypokalemia

Answer 31

saline-responsive metabolic alkalosis

Question 32

cause of metabolic alkalosis characterized by hypertension and edema

Answer 32

saline-unresponsive metabolic alkalosis

Question 33

what is the primary saline-unresponsive metabolic alkalosis?

Answer 33

hyperaldosteronism (excess mineralocorticoid) due to renal tumor

Question 34

what is the treatment for saline-responsive metabolic alkalosis? (6)

Answer 34

IV fluids IV KCl acetazolamide OR spironolactone stop diuretics stop NG tube suction and add PPI +/- dialysis

Question 35

what is the treatment for primary saline-unresponsive metabolic alkalosis? (4)

Answer 35

remove mineralocorticoid-producing tumor replete K replete spironolactone +/- O2 ventilation