Acid-Base

Question 1

The kidney is able to stabilize acid base by ?

Answer 1

altering either acid elimination (H+ excretion) or base elimination (HC03 excretion).

Question 2

The lung eliminates massive amounts of acid as (1), but if there is pulmonary disease, then the kidney excretes (2)

Answer 2

1. C02

2. H+ thereby raising the blood pH.

Question 3

In times of base excess, there is more (1) filtered, so the kidney eliminates more (1), thereby (2)

Answer 3

1. bicarbonate (HC03)

2. lowering the blood pH.

Question 4

Cells use the ability of carbonic anhydrase to catalyze the formation of C02 from (1) to achieve charge neutrality and add either (2) to the blood or the urine as needed.

Answer 4

1. hydrogen and bicarbonate

2. H+ or HC03

Question 5

Buffers such as (3) allow neutralization of pH without massive excretion of charged ions

Answer 5

3. phosphate and ammonia

Question 6

The simplest way to solve acid base problems is by first determining if there is an acidosis or alkalosis by evaluating the pH. If the pH is below the normal range (1), then there is (2), whereas if it is above the normal range, there is (3)

Answer 6

1. 7.35-7.45
2. acidosis
3. alkalosis.

Question 7

Next, evaluate whether the respiratory or metabolic component can explain the observed pH change. If an acidosis, then (1)

Answer 7

1. elevated pC02 or a reduced HC03

Question 8

Next, evaluate whether the respiratory or metabolic component can explain the observed pH change. If an alkalosis then (1)

Answer 8

1. reduced pC02 or an elevated HC03

Question 9

For example: If the pH is 7.2 and the pC02 is above the normal range (35-45 mm Hg), then the patient has (1). We may also expect to find (2) in such a patient, but that is the (3)

Answer 9

1. respiratory acidosis
2. an elevated HC03
3. compensatory metabolic alkalosis.

Question 10

In some patients with a metabolic acidosis, there are (1) present (2) which can be calculated by determining the (3)

Answer 10

1. excess anions
2. lactic from lactic acidosis or ketone bodies from diabetic ketoacidosis
3. anion gap

Question 11

Anion gap is calculated by (1). The normal range for the anion gap is usually between (2)

Answer 11

1. taking the sodium and then subtracting the Cl and HC03

2. 8-16.

Question 12

An anion gap should really only be present if there is a component of a (1) and not just as a compensation

Answer 12

1. metabolic acidosis

Question 13

Because the lung eliminates C02 as acid, (1) causes a respiratory alkalosis and (2) causes a respiratory acidosis.

Answer 13

1. hyperventilation

2. hypoventilation

Question 14

Hypoventilation can be caused by?

Answer 14

airway obstruction, neurological diseases (stroke, sleep apnea,Guillain-Barre), chest wall deformities, or pulmonary diseases such as asthma or COPD.
It can cause a respiratory acidosis

Question 15

Winter’s formula:

Checks if there is compensation for METABOLIC ACIDOSIS

Answer 15

PaCO2 = 1.5 {HCO3-} + 8

Question 16

anion gap formula

Answer 16

AG = [Na+] – ([HCO3-] + [Cl-])

Question 17

anion gap Determines cause of 1)

Answer 17

metabolic acidosis

Question 18

Normal Anion Gap

HARD-ASS

Answer 18

Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

Question 19

normal anion gap value

Answer 19

8-12 mEq/L

Question 20

Increased Anion Gap

Answer 20

Indicates accumulation of unmeasured anion.

Question 21

Diarrhea

Answer 21

Normal Anion Gap Metabolic acidosis

Question 22

Acetazolamide

Answer 22

Normal Anion Gap Metabolic acidosis

Question 23

Increased Anion Gap metabolic acidosis causes:

MUDPILES

Answer 23

Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron tablets or Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

Question 24

contraction alkalosis occurs secondary to ECF volume contraction; pH? and K?

Answer 24

pH is INCREASED

K is decreased;

Question 25

Diabetic Ketoacidosis

Answer 25

Increased Anion Gap metabolic acidosis

Question 26

Salicylates

Answer 26

Increased Anion Gap metabolic acidosis

Question 27

Lactic acidosis

Answer 27

Increased Anion Gap metabolic acidosis

Question 28

Vomiting

Answer 28

Metabolic alkalosis

Question 29

Bicarb is CONTRAINDICATED

Answer 29

Diabetic Ketoacidosis

Question 30

asthma, COPD, chronic fibrosis, and interstitial disease

Answer 30

Respiratory Acidosis

Question 31

Water Deficit =

Answer 31

DBW – CBW

Question 32

Desirable body water (DBW) =

Answer 32

(DBW) = (Current sodium/140) * CBW

Question 33

Current body water (CBW) =

Use 0.5 for females

Answer 33

0.6 * Body weight

Question 34

Insulin shifts K+ into cells –> leads to 1)

Answer 34

hypokalemia.

Question 35

Filtration fraction =

Answer 35

GFR/RPF where GFR is measured by creatinine clearance and RPF by PAH clearance

Question 36

RPF measured by 1)

Answer 36

PAH clearance