Acid-base cases

Question 1

1. Explain metabolic acidosis and differentiate non-anion gap from anion gap acidosis.

Answer 1

NAGMA: bicarbonate loss or not regenerated– diarrhea, renal tubular acidosis, aldosterone deficiency

AGMA: high acid input (ETHO, methanol, ethylene glycol, ASA) high acid production (shock, lactic acidosis, ketoacidosis) or low acid output: kidney failure

Question 2

2. Explain metabolic alkalosis and differentiate generation from maintenance causes.

Answer 2

generation: loss of H+ via GI secretion suction, urine, movement of hydrogen into cells
maintenance: activation of RAAS, decreased ECV, chloride depletion, hypokalemia

Question 3

3. Interpret data from arterial gasses and serum and urine studies in the diagnosis of acid-base disorders.

Answer 3

Evaluate:
pH
bicarb
anion gap
pCO2
determine primary disorder
determine if appropriate physiologic response

Question 4

Contrast conditions with an osmol gap and those without.

Answer 4

ketoacidosis, ethylene glycol, methanol, formaldehyde, paraldehyde

without: isopropanol, ether, mannitol