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Clinical Chemistry (me) > Acid Base Balance > Flashcards

Acid Base Balance Flashcards

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1
Q

How should we approach a blood gas interpretation?

A
  1. Categorize pH
  2. Identify metabolic process
  3. Identify respiratory process
  4. Identify primary and/or compensatory process (if present)
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2
Q

What will two primary processes look like on a blood gas?

A

Both respiratory and metabolic changes are contributing to the pH change

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3
Q

What are the endogenous and exogenous anions involved with titrational metabolic acidosis

A

Endogenous Anions

  1. Uremic acids = Renal azotemia
  2. Lactic acid = Lactic acidosis
  3. Ketoacids = Ketoacidosis (diabetes, pregnancy)

Exogenous Anions

  1. Ethylene glycol toxicity (glycolic, glyoxylic, oxalic acids)
  2. Salicylate/ Aspirin toxicity
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4
Q

What does the anion gap reflect?

A

The gap reflects unmeasured ions that are present

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5
Q

Very basic, what are ways to increase or decrease the anion gap?

A

Increase

  • increase unmeasured anions (albumin)
  • decrease unmeasured cations

Decrease

  • decrease unmeasured anions
  • increase unmeasured cations
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6
Q

What is the general interpretation of an increased anion gap?

A

Titrational metabolic acidosis

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7
Q

What is the usual association on the chemistry panel with titrational metabolic acidosis?

A

Decreased tCO2

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8
Q

What is the most common cause of a decreased anion gap?

A

Hypoalbuminemia

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9
Q

What should you consider with a negative anion gap?

A

Bromide

this is because bromide is measured as Cl

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10
Q

What is the primary Acid-Base profile?

A

TCO2
Anion gap
Chloride

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11
Q

What is the secondary Acid-Base profile?

A

Potassium

Urine pH

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12
Q

What are 4 major reasons you would associate with increased tCO2 (metabolic alkalosis)?

A
  1. GI loss of HCl (vomit), abomasal sequestration
  2. Hypoalbuminemia
  3. Renal (paradoxical aciduria)
  4. Respiratory acidosis
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13
Q

What will you see with a metabolic alkalosis due to GI situation?

A

Increased TCO2 with decrease in Cl (seperate from Na)

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14
Q

In what clinical conditions should make you think about paradoxical aciduria?

A
  1. GI obstruction/vomiting
  2. Displaced abomasum
  3. Electrolyte depletion (Na, K, Cl)
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15
Q

What are the two biggest contributing factors (in the blood) to paradoxical aciduria?

A

Hypochloremia

Hypokalemia

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16
Q

What are the two driving forces of paradoxical aciduria?

A

Need for sodium re-absorption (dehydration, hypoNa)

Alkalosis

17
Q

What is renal tubular acidosis (RTA)?

A

Acidemia with alkaluria

“inadequate acidification of urine”

18
Q

What are the two major types of RTA? Explain the cause.

A

Proximal RTA - Can’t re-absorb HCO3

Distal RTA - Can’t secrete H

19
Q

What urine pH changes will you see with the progression of proximal RTA?

A

Early: alkaline urine
Later: acid urine (deplete blood HCO3)

20
Q

What will you see on the primary acid base profile with hypoproteinemic alkalosis?

A

TCO2 alone or with chloride may be in upper reference range (unusual pattern b/c Cl always runs from TCO2)… In this case both are available to compensate

21
Q

What are 3 causes for secretional metabolic acidosis?

A
  1. GI/pancreatic secretions (obstruction, diarrhea)
  2. Saliva loss (mainly ruminants in choke)
  3. Urinary loss (proximal RTA)
22
Q

Chloride increased relative to sodium suggests a decreased __________ and is interpreted as evidence for _______________

A

tCO2

Metabolic acidosis

23
Q

Chloride decreased relative to sodium suggests an increase in __________ and is interpreted as evidence for _______________

A

tCO2

Metabolic alkalosis

24
Q

How will we characterize a titrational metabolic acidosis based on the primary acid base profile?

A

Decrease TCO2
Increased AG
Normal Cl relative to Na (+/- 3)

25
Q

How will we characterize a secretional metabolic acidosis based on the primary acid base profile?

A

Decrease TCO2
Normal AG
Increase Cl relative to Na

26
Q

What changes will you see on the secondary acid base profile for acidosis?

A

Hyperkalemia to HN

- Hydrogen goes into cells, potassium comes out

27
Q

What changes will you see on the secondary acid base profile for alkalosis?

A

Hypokalemia to LN

- Hydrogen comes out of cells, potassium goes in

28
Q

Primary profile is use to ___________

A

define the disorder

29
Q

Secondary profile is used to ______________

A

confirm corrective measures are appropriate

30
Q

What are two critical findings related to potassium and the secondary renal profile?

A
  1. Hypokalemia + metabolic acidosis

2. Hypokalemia + unregulated DM patient

31
Q

What are some factors that can contribute to change in urine pH?

A
  1. Postprandial alkaline tide
  2. Post renal factors:
    - urease + bacteria (Staph, Proteus, Mycoplasma)
    - sample handling

Clinical Chemistry (me) (4 decks)

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