Acid Base Disease

Question 1

What is the Chemical equation for the Bicarbonate Buffer?

Answer 1

H + HCO3 H2CO3 H2O + CO2

Question 2

What is the pH range compatible with life?

Answer 2

Tightly held at 7.40
range compatible with life is 6.80 to 7.80
H+ is inversely related to pH

Question 3

what is the definition of Acidosis and Alkalosis?

Answer 3

Acidosis: pH 7.45

Question 4

What is the Physiologic Change associated with Metabolic Alkalosis?

Answer 4

Increased HCO3

Question 5

What is the Physiologic Change associated with Metabolic Acidosis?

Answer 5

Decreased HCO3

Question 6

What is the Normal level of Bicarbonate?

Answer 6

25 mmol/L

Question 7

What Bicarb level equates to Metabolic Alkalosis?

Answer 7

> 40 mmol/L

Question 8

What condition maintains metabolic Alkalosis?

Answer 8

Condition resulting in inability to secrete HCO3 by the kidneys

Question 9

What are causes of Metabolic Alkalosis?

Answer 9

GI Hydrogen loss: Vomiting/NG
Renal Hydrogen loss
-1^ Aldosteronism
-Loop or thiazide diuretics
IC Shift of hydrogen
Alkali administration
Contraction alkalosis
-Massive Diuresis

Question 10

How is Contraction alkalosis Caused and Maintained?

Answer 10

Cause: Diuretics- secretion of H+ and K+ with vol loss
Maint: Hyperaldosterone- Counteractis hypovolemiaand promotes Na/Water/bicarb retension and K/H secretion

Question 11

What is the Tx of Metabolic Alkalosis?

Answer 11

Correct underlying cause: Stop NG suction and Diuretics
AND Maintainers
CORRECT Electrolyte Abn. Requires NaCl or KCl fluid resuscitation
Acetazolamide

Question 12

What bicarb level is associated with Metabolic acidosis?

Answer 12

Bicarb

Question 13

What is the equation for anion gap?

Answer 13

[Na]- ([Cl] + [HCO3])

Question 14

What are the unmeasured ions?

Answer 14

SO4, PO4, organic acids, intoxicants and their metabolites

Question 15

What are rhe measured anions?

Answer 15

Na+, Cl- and HCO3-

Question 16

What is a normal Anion Gap?

Answer 16

8-10 +/- 2

USE 12mmol/L while calculating

Question 17

What will increase anion gap?

Answer 17

Increase in unmeasured ions

Question 18

What are rhe measured cations?

Answer 18

Ca++, K+, Mg+

Question 19

What are the causes of High AG Metabolic Acidosis?

Answer 19

MUDPILES
Methanol
Uremia
DKA *
Propylene glycol
Infection, Iron, Isoniazid
Ethylene glycol
Salicylates

Question 20

What is the triad of DKA?

Answer 20

Hyperglycemia
High AG metabolic Acidosis
Ketonemia

Question 21

What are the common causes of Increased Serum osmolal Gap?

Answer 21

Methanol intox

Ethylene glycol intox

Question 22

What is Methanol Metabolized to? S and S?

Answer 22

Formaldehyde/formic acid

CNS/retinal injury/ pancreatitis

Question 23

What is Ethylene glycol metabolized to? S and S?

Answer 23

Oxylate, hippurate

Neuro/Cardiopulm collapse/Ca oxalate crystals in urine

Question 24

What are the early S and S of Aspirin intoxication?

Answer 24

Tinnitus, vertigo, N/V/D

Question 25

What are the Acid Base effects of ASA intox?

Answer 25

Initial: Resp Alkalosis
Later: High AG metabolic Acidosis
Net: Mixed: Resp alkalosis AND Metabolic Acidosis

Question 26

What is the Tx of ASA Intox

Answer 26

Activated Chatrcoal
BICARBONATE
monitor serum ASA conc
>100 mg/dL ABSOLUTE INDICATION FOR HEMODIALYSIS