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Acid Base 2 Flashcards

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1
Q

What is the presentation of acute metabolic acidosis?

A

pH < 7.2
Hyperventilation
Bradycardia/HF
Obtundation/confusion

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2
Q

What acidic pH is incompatible with life?

A

6.7

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3
Q

What is the presentation of chronic metabolic acidosis?

A

pH 7.2 - 7.34

Relatively asx

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4
Q

What are causes of chronic metabolic acidosis?

A

Renal tubular acidosis

Chronic renal insufficiency

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5
Q

What are the causes of bone demineralization?

A 
Children = Rickets (growth failure, weight loss)
Adults = Osteopenia (RTA, CRI)
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6
Q

What does a metabolic acidosis with a normal anion gap represent?

A

Decreased HCO3
Increased Cl
Keeps electroneutrality

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7
Q

What is a cause of metabolic acidosis with a normal anion gap?

A

Excessive diarrhea

Intrinsic Renal Disease (RTA)

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8
Q

What is a clinically relevant anion gap?

A

greater than 17

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9
Q

How does excessive diarrhea cause hyperchloremic metabolic acidosis?

A

Pancreatic secretions are rich in bicarbonate
Excessive loss of bicarb results in excessive reabsorption of H+
Cl reabsorbed (as part of this exchange) = minimizes gap

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10
Q

How does intrinsic renal disease cause hyperchloremic metabolic acidosis?

A

Normally, H+ ions are almost entirely eliminated by kidneys
RTA = inability to eliminate H+
Prevents reabsorption of bicarb, and Cl is retained

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11
Q

What is another name for a metabolic acidosis with a normal anion gap?

A

Hyperchloremic metabolic acidosis

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12
Q

What causes an increased anion gap in metabolic acidosis?

A

Presence of organic acids (lactic acids, ketoacids, and uremic acids) or toxins
Acids/toxins consume bicarb becoming anions
See a decreased bicarb with increased chlorine

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13
Q

What does MUDPILES stand for?

A 
Methanol
Uremia
DKA
Propylene glycol
Isoniazid
Lactic acid
Ethanol
Salicylates
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14
Q

What are the sources that increase the anion gap?

A

DKA
Uremia
Ethanol
Lactic acidosis

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15
Q

What is the treatment strategy for severe metabolic acidosis?

A

pH < 7.2
Goal pH = 7.2
Goal HCO3 = 10-12
Give IV sodium bicarb

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16
Q

What is the dose of bicarb in a vial?

A

50meq/50mL

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17
Q

How do we calculate the sodium bicarbonate dosage?

A

(0.5L/kg x wt) x (Goal bicarb - current bicarb)

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18
Q

What is the target serum bicarb for severe metabolic acidosis?

A

10-12 in 24 hours

Administer 50% over 4 hours, then last 50% over next 20 hours

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19
Q

What is the target serum bicarb for moderate metabolic acidosis?

A

22-24 over 3-5 days

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20
Q

What are problems with administered bicarb IV?

A

Systemic overshoot (excessive dosing in DKA, lactic acidosis, ARF, ?Ethanol)
Severe hypernatremia
Extravasation

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21
Q

What is a problem with administering oral bicarb

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A

GI intolerance

22
Q

What is the treatment strategy for moderate metabolic acidosis?

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A

pH 7.2 - 7.34
Goal pH = 7.4
Goal bicarb = 22-26
Give oral bicarb

23
Q

What is severe alkalosis?

24
Q

What pH is incompatible with life?

25
What os the presentation of metabolic alkalosis?
Hypovolemia Hypervolemia pH > 7.6
26
What are the affects of a pH > 7.6?
``` Cardiac arrhythmias NM irritability (tetany/tremors) ```
27
What are the causes of metabolic alkalosis?
Increased bicarb retention Increased bicarb concentration Hyperaldosteronism
28
What causes bicarb retention?
Loss of H+ ions Nasogastric suctioning Vomiting
29
What causes increased bicarb concentrations?
Diuretics from contraction alkalosis
30
What diseases cause hyperaldosteronism?
Cushing's | Hyperaldosteronism
31
How does hyperaldosteronism cause metabolic acidosis
Promote hyper renin states
32
If a patient has metabolic alkalosis and is hypovolemic, how do we treat them?
IV NaCl
33
If a patient has metabolic acidosis and is euvolemic, how do we treat them?
Aldosterone antagonist
34
If a patient has a pH greater than 7.6, how do we treat them?
Hydrochloric acid
35
What is the presentation of respiratory alkalosis?
Hyperventilation CNS (agitation/anxiety, lightheadedness) CV (chest pain)
36
What are the results of hyperventilation?
Decreased CO2 Lightheadedness, confusion, syncope N/V Muscle cramps, tetany
37
What are the causes of hyperventilation?
CNS mediated Medications Others
38
What CNS causes are associated with hyperventilation?
``` Pain Anxiety Fever Head trauma CVA ```
39
What medications are associated with hyperventilation?
Theophylline Nicotine Catecholamines
40
What are other causes of hyperventilation?
Severe anemia High altitude Hyperthyroidism
41
What is the treatment strategy if the patient has respiratory alkalosis and their pH is < 7.6?
Remove underlying cause
42
When do we give O2 in respiratory alkalosis?
PaO2 < 50
43
What is the treatment for respiratory alkalosis with a pH > 7.6?
Mechanical ventilation
44
What is severe acidosis?
pH < 7.2
45
What acidosis is incompatible with life?
< 6.7
46
What is the cause of respiratory acidosis?
``` Failure of lungs to eliminate CO2 Ventilatory failure (Obstructive lung dz/NM dz) Perfusion failure (Massive PE) ```
47
What is the presentation of respiratory acidosis?
Compatible with life despite paCO2 80-100 No longer dependent on Co2 for respiratory drive Dependent on O2 for respiratory drive
48
What patients are highly susceptible to acute respiratory decompensation?
Acute respiratory infections Narctoic analgesics Sedative/hypnotics O2 (CO2 narcosis)
49
When do we give mechanical ventilation?
Acute respiratory acidosis PaCO2 > 80 or PaO2 < 40
50
When do we give O2 in respiratory acidosis?
Chronic respiratory acidosis | PaO2 < 50

Respiratory (8 decks)

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