acid base balance

Question 1

what are the causes of increased anion gap metabolic acidosis?

Answer 1

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

Question 2

what are the causes of normal anion gap metabolic acidosis?

Answer 2

RABUC
acid administration
bicarbonate loss
ureterosigmoidostomy
renal tubular acidosis
carbonic anhydrase inhibitor

Question 3

The human body has to keep the …… concentration within a certain narrow range in
order to perform its normal functions and survive

Answer 3

H+

Question 4

The balance of H+ is maintained intracellularly by the …………, and extracellularly by the
………..buffering systems.

Answer 4

+buffering
systems of proteins and phosphates.
+bicarbonate-carbonic acid

Question 5

Metabolic disorders are detected through chemoreceptors
sensitive to H+ in the …………… and brain stem,

Answer 5

carotid body

Question 6

ventilation is accelerated in …………….., and ventilation
is slowed in …………..

Answer 6

+metabolic acidosis
+metabolic alkalosis

Question 7

In respiratory disorders, ……. reabsorption through the
kidneys is increased or decreased.

Answer 7

HCO3

Question 8

***what are the most common causes of
CHRONIC metabolic acidosis?

Answer 8

chronic kidney diseases

Question 9

***what are the most common causes of ACUTE metabolic
acidosis.

Answer 9

+diabetic ketoacidosis and
+lactic
acidosis

Question 10

**The cause of metabolic acidosis in the surgical patient is often
…………

Answer 10

lactic acidosis.

Question 11

how would you treat Lactic acidosis?

Answer 11

Lactic acidosis develops due to insufficient tissue perfusion.
The treatment is to restore tissue perfusion with volume
resuscitation/replacement rather than by giving bicarbonate.

Question 12

The invariable rule of metabolic acidosis with a normal anion
gap is the presence of ……………

Answer 12

hyperchloremia

Question 13

………..is the most common cause of HYPERchloremic metabolic acidosis with hypokalemia.

Answer 13

Diarrhea

Question 14

Pancreatic and intestinal fistulas can lead to loss of bicarbonate, leading to …………..

Answer 14

metabolic acidosis

Question 15

what are the Emergency management of metabolic acidosis?

Answer 15

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)

Question 16

hyperkalemia is a result of which acid imbalance?

Answer 16

acidosis/ketoacidosis

Question 17

hyperventilation/hypoventilation results in a rise of pCO2.

Answer 17

hypoventilation

Question 18

hyperventilation/hypoventilation results in a decrease of pCO2.

Answer 18

hyperventilation

Question 19

Hypokalemia is accompanied by …..

Answer 19

metabolic alkalosis

Question 20

Hypokalemia is accompanied by …..

Answer 20

metabolic alkalosis

Question 21

Etiology of Metabolic Alkalosis

Answer 21

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

Question 22

what is the treatment for metabolic alkalosis?

Answer 22

1-Re-expand volume with Normal Saline ( Primary Therapy)
2-Potassium repletion

Question 23

respiratory acidosis Occurs with CO2 retention due to a decrease in ………….

Answer 23

alveolar ventilation

Question 24

where does Respiratory acidosis stem from?

Answer 24

from insufficient ventilation to affect respiratory mechanics.
and NOT in respiratory disorders, which means gas exchange at the level of the alveolar membrane.

Question 25

why does Hypocapnia occurs in Respiratory alkalosis?

Answer 25

Hypocapnia occurs with an increase in respiratory rate due to hypoxia in respiratory disorders such as pneumonia

Question 26

Etiology of Respiratory Acidosis

Answer 26

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

Question 27

Treatment of Respiratory Acidosis

Answer 27

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.
)

Question 28

treatment for Respiratory Alkalosis

Answer 28

Treatment should be directed at the underlying cause, but controlled ventilation may be required to correct hyperventilation.
(which causes resp alkalosis)

Question 29

………………….can cause hypokalemia, hypophosphatemia and hypocalcemia by introducing potassium and phosphate into the cell and increasing the binding of calcium to albumin.

Answer 29

Respiratory Alkalosis

Question 30

Pain, anxiety, neurological disorders and hyperventilation are the most common causes of ………………..

Answer 30

Respiratory Alkalosis

Question 31

*what are the 2 common causes of metabolic acidosis?

Answer 31

-lactic acidosis
-diabetic ketoacidosis

Question 32

what are the causes of HAGMA(high anion gap metabolic acidosis)?

Answer 32

MUDPILES:
-metabolic acidosis
-uremia
-diabetic ketoacidosis
-polyethylene glycol
-isoniazide/iron toxicity
-lactic acidosis
-ethanol/ethylene glycol
-Salicylate

Question 33

in which cases respiratory acidosis DOESN”T occur?

Answer 33

IN RESPIRATORY DISORDERS SUCH AS
PNEUMONIA
PULMONARY EMBOLISM AND
ACUTE LUNG INJURY

Question 34

Low chlorine (hypochloremic) diarrhea causes….?

Answer 34

Metabolic alkalosis(WITH HYPOKALEMIA)

Question 35

High chlorine (hyperchloremic) diarrhea causes….?

Answer 35

Metabolic acidosis

Question 36

Diarrhea always causes …..?

Answer 36

Hypokalemia