Acid Base Flashcards
What is the anion gap?
High anion gap indicates?
Low gap?
Gap= Na - (Cl - HCO3)
High: acid anions
Low: Low albumin +/- High Igs (Myeloma, AIDS, cirrhosis)
Total CO2 content is calculated by?
Osmotic gap calculated?
Increase indicates?
Measured how?
Sum of Bicarbonate, Carbonic acid + Carbamino compounds= Total CO2; usually 1-2 mmol/L higher than true bicarb
Measued osmolality vs calculated=(2*Na + (BUN/3) + (Glucose/20))
Indicated unchaged substances (alcohols/volatiles, glycols)
Freezing point depression; doesn’t measure volitiles
What tube inhibits glycolysis?
What ketone is dominat?
NaF tube; Gray top
B-OH butyrate is dominant but not a true ketone and missed on dipstick and methods that measure ketones; many just measure this
On boards compensated Acid-base disorder has pH near?
On boards combined disorders move in the same or opposite directions?
Normal! ~7.4
Same!
In metabolic disorders do Ph, PCO2, HCO3 move in the same direction?
High anion gap is seen in?
YES!; in respiratory pCO2 and HCO3 move in one direction and pH in opposite direction
Metabolic acidosis; anion gap can be normal as well
In what acid-base disorder is chloride unchanged?
Causes of anion gap metabolic acidosis?
Non-anion gap, what renal tubular acidosis has normal K+?
Which has type of RTA has lowest K+?
Anion gap metabolic acidosis; lactate and acetoacetate common; **except salicylate
Overproduction; Renal failure rare, or ESCR disease**
Non-anion: GI and Renal loss; diarrhea, RTA; Type 4; all others have low K+
T1 really low (high 1-low 2); T2 (low to normal; upper 2-3); Type 4 (aldosterone activity/response high; can’t excrete it)
Acid over production DUMBSALE?
Diabetic ketoacidosis
Ureamia
Methanol
Paraldehyde
Salicylates
-OH Ketoacidosis
Lactic acidosis
Ethylene glycol
Methabolic alkalosis bicarb level and pH?
Causes of metabolic alkalosis?
Why is urine chloride important?
High CO3-, high pH low K+
Loss of acid or over excretion of acid: vomiting and dehydration (Low urine Cl)
Excess mineralocorticoids (Cushing); High urine Cl
Cause of respiratory acidosis?
pCO2 levels?
Causes of respiratory alkalosios?
pCO2/pH?
Alveolar ventilation, COPD, Respiratory depression, chest wall injury, etc.
High!; lowers pH
Respiratory alkalosis: Hyperventillation, acute pain, Chronic hypoxia due to high pCO2—right to left shunting and interstital lung disease
Low pCO2, high pH
What causes high oxygen affinity (left shift)?
What causes low oxygen affinity (right shift)?
Left shift=less delivery to tissue; lower temp, lower 2-3 DPG, low H+, **CO; “Oxygen LEFT on hemoglobin”
Right shift=more O2 delivery; Increased temp, Increased 2-3 DPG, increased H+; think exercise and “Right into the tissues/ right thing to do”**
Intracellular fluid high in?
Extracellular high in?
Plasma sodium measurements can be low in what cases?
If urine is dilute what does that tell you about ADH?
K+, PO4, Protein
Na, Cl; interstital fluid low in protein and intravascular plasma high in protein
When patients have increased protein and lipids (indirect and flame); Na activity machines not affected
ADH activity is decreased; should reabsorb water from urine
Most common cause of hypernatremia?
Causes of hyponatremia?
Fluid loss without replacement; infants, bed bound, dementia, neurologic disorders, rare diabetes insipidus/hypertonic solutions
Hypo: Pseudohyponatremia, Osmotic water shifts (Glucose), Na wasting (renal, extrarenal), Excess water (SIADH, polydipsia), Edematous states (cirrhosis, CHF, nephrotic syndrome)
Artifactural increase in Hyperkalemia?
Ture due to?
Hemolysis, EDTA contamination (lavender, potassium EDTA) , fist clenching/relaxing during draw,
thrombocytosis (serum; clotted because plts release K+ when clotting) or lymphocytosis (plasma only; hepranized–green top)
True; Decreased exretion (Renal failure, low aldosterone–Type 4 RTA); Shift of K+ out of cells (cell lysis, acidosis, low insulin); Increased intake
Hypokalemia can be caused by?
Increased excretion (diuretics, hyperaldosteron RTA, low Mg); GI losses (vomiting, diarrhea), decreased intake, shift of K+ into cells (correction of insulin deficiency, refeeeding, alkalosis)
CEA good marker for?
AFP increased in what tumors, what variant more specific for HCC?
Colon, increase is 25% local; 70-90% metastatic; Also found in GI, Pancreas, lung, uterus, and breast
AFP: >100x increase specific for HCC (50% sensitive), yolk sac tumor; may have minor increase in hepatocyte regeneration, L3 variant more specific for HCC
