acid base balance Flashcards
what are the causes of increased anion gap metabolic acidosis?
1)Exoogenous acid intake
s.a consumption of alcohol
a-methanol
b-ethylene glycol
c- salicylate
2)Endogenous acid prod:(KLK)
a-ketoacidosis(accumulation of ketones due to lack of insulin ;to
compensate low sugar)
b-lactic acidosis(impaired elimination of lactic acid due to liver
failure)
c-kidney failure
what are the causes of normal anion gap metabolic acidosis?
RABUC
acid administration
bicarbonate loss
ureterosigmoidostomy
renal tubular acidosis
carbonic anhydrase inhibitor
The human body has to keep the …… concentration within a certain narrow range in
order to perform its normal functions and survive
H+
The balance of H+ is maintained intracellularly by the …………, and extracellularly by the
………..buffering systems.
+buffering
systems of proteins and phosphates.
+bicarbonate-carbonic acid
Metabolic disorders are detected through chemoreceptors
sensitive to H+ in the …………… and brain stem,
carotid body
ventilation is accelerated in …………….., and ventilation
is slowed in …………..
+metabolic acidosis
+metabolic alkalosis
In respiratory disorders, ……. reabsorption through the
kidneys is increased or decreased.
HCO3
***what are the most common causes of
CHRONIC metabolic acidosis?
chronic kidney diseases
***what are the most common causes of ACUTE metabolic
acidosis.
+diabetic ketoacidosis and
+lactic
acidosis
**The cause of metabolic acidosis in the surgical patient is often
…………
lactic acidosis.
how would you treat Lactic acidosis?
Lactic acidosis develops due to insufficient tissue perfusion.
The treatment is to restore tissue perfusion with volume
resuscitation/replacement rather than by giving bicarbonate.
The invariable rule of metabolic acidosis with a normal anion
gap is the presence of ……………
hyperchloremia
………..is the most common cause of HYPERchloremic metabolic acidosis with hypokalemia.
Diarrhea
Pancreatic and intestinal fistulas can lead to loss of bicarbonate, leading to …………..
metabolic acidosis
what are the Emergency management of metabolic acidosis?
intubation and ventilation for airway or ventilatory control; CPR.
Next: Treat the underlying disorder as the primary therapeutic goal.
Then: Replace losses(volume
resuscitation/replacement)
hyperkalemia is a result of which acid imbalance?
acidosis/ketoacidosis
hyperventilation/hypoventilation results in a rise of pCO2.
hypoventilation
hyperventilation/hypoventilation results in a decrease of pCO2.
hyperventilation
Hypokalemia is accompanied by …..
metabolic alkalosis
Hypokalemia is accompanied by …..
metabolic alkalosis
Etiology of Metabolic Alkalosis
1-Increased bicarbonate production
a-Chlorine loss (urine chlorine>20 mEq/L)
b-Chlorine retention (urine chlorine<20mEq/L
c- Giving a high amount of alkali
2-Impaired bicarbonate excretion
a-Decreased glomerular filtration
b-Increased bicarbonate reabsorption
what is the treatment for metabolic alkalosis?
1-Re-expand volume with Normal Saline ( Primary Therapy)
2-Potassium repletion
respiratory acidosis Occurs with CO2 retention due to a decrease in ………….
alveolar ventilation
where does Respiratory acidosis stem from?
from insufficient ventilation to affect respiratory mechanics.
and NOT in respiratory disorders, which means gas exchange at the level of the alveolar membrane.
why does Hypocapnia occurs in Respiratory alkalosis?
Hypocapnia occurs with an increase in respiratory rate due to hypoxia in respiratory disorders such as pneumonia
Etiology of Respiratory Acidosis
1-Narcotics
2-Central nervous system damage
3-Pulmonary s.a Mucus plug
4-Pain due to abdominal or thoracic injury or incision
5-Restricted diaphragm movement due to intra-abdominal pathology
Treatment of Respiratory Acidosis
Correction of hypoxia is more important in these patients.
Corticosteroids and bronchodilators to reduce airway inflammation and resistance
(A common mistake is to over-ventilate the patient.
)
treatment for Respiratory Alkalosis
Treatment should be directed at the underlying cause, but controlled ventilation may be required to correct hyperventilation.
(which causes resp alkalosis)
………………….can cause hypokalemia, hypophosphatemia and hypocalcemia by introducing potassium and phosphate into the cell and increasing the binding of calcium to albumin.
Respiratory Alkalosis
Pain, anxiety, neurological disorders and hyperventilation are the most common causes of ………………..
Respiratory Alkalosis
*what are the 2 common causes of metabolic acidosis?
-lactic acidosis
-diabetic ketoacidosis
what are the causes of HAGMA(high anion gap metabolic acidosis)?
MUDPILES:
-metabolic acidosis
-uremia
-diabetic ketoacidosis
-polyethylene glycol
-isoniazide/iron toxicity
-lactic acidosis
-ethanol/ethylene glycol
-Salicylate
in which cases respiratory acidosis DOESN”T occur?
IN RESPIRATORY DISORDERS SUCH AS
PNEUMONIA
PULMONARY EMBOLISM AND
ACUTE LUNG INJURY
Low chlorine (hypochloremic) diarrhea causes….?
Metabolic alkalosis(WITH HYPOKALEMIA)
High chlorine (hyperchloremic) diarrhea causes….?
Metabolic acidosis
Diarrhea always causes …..?
Hypokalemia
