Acid-Base

Question 1

Normal pH?

Answer 1

7.4

Question 2

Normal CO2?

Answer 2

40

Question 3

Normal HCO3-?

Answer 3

24

Question 4

Normal Anion Gap?

Answer 4

12

Question 5

Equation for calculating Anion Gap?

Answer 5

(Na) – (HCO3 + Cl) … calculate AG, even if patient has alkalosis

Question 6

Equation for Delta Anion Gap?

Answer 6

(AG – NML AG) + HCO3

Question 7

NML value for Delta Anion Gap + HCO3?

Answer 7

NML = 20-30

Question 8

Value for Delta Anion Gap + HCO3 that indicates metabolic acidosis?

Answer 8

< 20

Question 9

Value for Delta Anion Gap + HCO3 that indicated metabolic alkalosis?

Answer 9

> 30

Question 10

Purpose of Winter’s Formula in evaluation of Acid-Base Disorder?

Answer 10

If patient has metabolic acidosis, check for concomitant respiratory disorder

Question 11

Equation for Winter’s Formula?

Answer 11

Expected CO2 = 1.5*(HCO3) + 8 (+/-) 2

Question 12

According to Winter’s Formula, if actual CO2 is less than expected CO2 …

Answer 12

Concomitant respiratory alkalosis

Question 13

According to Winter’s Formula, if actual CO2 is greater than expected CO2 …

Answer 13

Concomitant respiratory acidosis

Question 14

35 yo male presents with pyelonephritis; Labs show pH = 7.55, CO2 = 29, O2 = 64; Na = 145, K = 3.0, Cl = 97, HCO3 = 20 – diagnosis?

Answer 14

Respiratory Alkalosis + AG Metabolic Acidosis + Metabolic Alkalosis (delta AG + HCO3 = 48)

Question 15

62 yo female presents with vomiting; Labs show pH = 7.54, CO2 = 47; Na = 152, K = 5.7, Cl = 89, HCO3 = 42 – diagnosis?

Answer 15

Metabolic Alkalosis + AG Metabolic Acidosis + Metabolic Alkalosis (delta AG + HCO3 = 49)

Question 16

32 yo female presents for panic attack; Labs show pH = 7.51, CO2 = 24; Na = 146, K = 3.8, Cl = 102, HCO3 = 20 – diagnosis?

Answer 16

Respiratory Alkalosis + AG Metabolic Acidosis + Metabolic Alkalosis (delta AG + HCO3 = 32)

Question 17

43 yo female presents with suspected spontaneous bacterial peritonitis; Labs show pH = 7.25, CO2 = 26, O2 = 78; Na = 138, K = 5.1, HCO3 = 12, Cl = 99 – diagnosis?

Answer 17

AG Metabolic Acidosis

Question 18

Equation for osmolarity?

Answer 18

(2*Na) + (BUN/2.8) + (BG/18)

Question 19

3 most common causes of elevated osmolarity?

Answer 19

Methanol, Ethylene glycol, Isopropyl alcohol

Question 20

How can you distinguish between high osmolarity caused by Methanol + Ethylene glycol vs. Isopropyl alcohol?

Answer 20

Methanol + Ethylene glycol = AG metabolic acidosis; Isopropyl alcohol = No acidosis

Question 21

Shared feature between Isopropyl alcohol + Ethanol intoxication?

Answer 21

Both present with ketonuria

Question 22

How can you distinguish between Isopropyl alcohol and Ethanol intoxication?

Answer 22

Ethanol intoxication = high AG

Question 23

Setting of methanol poisoning?

Answer 23

Wood ETOH, contaminated moonshine

Question 24

Clinical presentation of methanol poisoning?

Answer 24

Visual impairment

Question 25

2 steps of treatment for methanol poisoning?

Answer 25

Hemodialysis, Fomepizole

Question 26

MOA of Fomepizole in treatment of methanol poisoning?

Answer 26

Inhibits alcohol dehydrogenase

Question 27

Clinical presentation of ethylene glycol intoxication?

Answer 27

Calcium oxalate crystals in urine

Question 28

Best treatment of ethylene glycol intoxication?

Answer 28

Thiamine, Vitamin B6

Question 29

Clinical presentation of Isopropyl alcohol intoxication?

Answer 29

High ketones

Question 30

Best treatment of Isopropyl alcohol intoxication?

Answer 30

IV fluids, supportive care