acid base balance Flashcards
long term acidosis can lead to which organ failure?
kidney failure
acute acidosis problem ion
hyperkalemia
ingested acid eg aa’s is called
titrable acid
methanol poisoning which acid do you get
formic acid
CO poisoning
lactic acidosis
hypotension/hypoxia
impaired aerobic respiration ->anaerobic -> lactic acidosis
diabetes or starvation
beta hydroxybutarate or acetoacetate
what do strong acids do in water
completely dissociated
desire to breathe is goverened by
pCO2 and low pH
breathing off C02 does not regenerate…
bicarbonate buffer
vast majority of bicarb is reabsorbed at
proximal tubule
ammonium is made from
glutamine -> glutamate-> alpha ketoglutarate picks up protons
2 buffers in urine/kidneys
ammonium and phosphate (from diet)
resp acidosis/alkalosis primarily prob with which gas
CO2
met acidosis primary prob
low bicarb
high anion gap
added acid eg meths
normal anion gap
loss of bicarb
what electrolytes normally measured
K+, Na+, HCO3-, Cl-
how to calculate anion gap
K and Na - Bicarb and Cl
normal anion gap
normally diarrhoea - loss of bicarb
high anion gap
added acid
metabolic acidosis
H
when arterial blood gas
resp distress
ABE
how much base needs to be added to get pH to normal
abg artery
radial
hyperventilation
alkalosis, low CO2
!!!O2 should be normal
target sats in copd
88-92
asthmatic becomes acidotic
very worrying - they’re gettin tired
resp acidosis (3)
reduced ventilation drive
tired asthmatic
opiates
neuromusc or chest wall disease - kyphoscoliosed
why calculate anion gap
decide whether loss of bicarb or added acid
what is normal anion gap
12-16 mmol/l
young pt met acidosis high anion gap
think DKA
raised lactate
tissue hypoxia/poor perfusion
altered cellular resp
e.g. ischaemic bowel or diabetic foot about to drop off
moribund
grey, deathly
high potassium in acidosis could indicate…
renal failure
metabolic acidosis -»»>
CALCULATE ANION GAP
why is anion gap normal in bicarb diarrhoea
CL-rises to rectify electrical neutrality
what is renal tubular acidosis
1) distal - can’t get rid of H+
2) proximal can’t resorb bicarb
4) hyperkalemic - diabetics
consequences of acidosis
acute (4)
chronic (3)
why kidney stones in acidotic
calciuria bone resorption
long term steroid can indiuce
hyperaldosteronism because adrenal insufficiency - H+ is lost
Cushing’s, mania, diabetes, all sorts of shit
