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Renal :') > Acid-Base Disorders > Flashcards

Acid-Base Disorders Flashcards

1
Q

what is the range of normal arterial pH?

A

7.35-7.45

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2
Q

what is the range for normal intracellular pH?

A

7.0-7.3

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3
Q

what is the effect of HCO3 on pH?

A

it increases pH

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4
Q

what is the effect of pCO2 on pH?

A

it causes a decrease in pH

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5
Q

how is metabolic acidosis defined?

A

low serum levels of HCO3-

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6
Q

how is metabolic alkalosis defined?

A

increased levels of HCO3-

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7
Q

how is respiratory acidosis defined?

A

increased levels of pCO2

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8
Q

how is respiratory alkalosis defined?

A

low pCO2

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9
Q

what are the different kinds of metabolic acidosis?

A

High anion gap metabolic acidosis and normal anion gap acidosis (aka hyperchloremic acidosis)

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10
Q

how many acid-base disturbances can be present at the same time?

A

three is the most possible since it is not possible to breathe fast and slow at the same time

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11
Q

what are the standardized steps to approaching a patient with symptoms suggesting an acid-base disturbance?

A

1) determine if acidosis or alkalosis is present 2) determine if the primary disturbance is metabolic or respiratory 3) if metabolic acidosis is present, calculate the anion gap 4) calculate appropriate compensation for primary acid-base disorder

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12
Q

what is the value that defines acidosis?

A

anything less than 7.35

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13
Q

what is the value that defines alkalosis?

A

anything greater than 7.45

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14
Q

what is the normal range for pCO2?

A

35-45

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15
Q

what is the normal range for HCO3-?

A

22-26

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16
Q

what is the normal range for anion gap?

A

10 (+/- 5 or 6 ie 5-16)

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17
Q

what is the normal range for osmolality gap?

A

10-15

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18
Q

how do you calculate anion gap?

A

Na - (HCO3- + Cl-)

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19
Q

why is an anion gap clinically used?

A

to differentiate the etiologies of metabolic acidosis (HAGMA or NAGMA), to diagnose paraproteinemias (low anion gap levels), to diagnose lithium, bromide, or iodide intoxications (low or negative anion gap levels)

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20
Q

if you discover HAGMA in a patient, what should you do next?

A

calculate the osmolarity gap

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21
Q

how do you calculate the osmolarity gap?

A

osmolarity gap= measured osmolality- calculate osmolality

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22
Q

how do you find the calculated serum osmolality?

A

2(Na) + (glucose/18) + (BUN/2.8)

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23
Q

what is a normal osmolality gap?

A

anything 10 or less

24
Q

what does it mean if a patient has an osmolality gap greater than 10?

A

it is suggestive of additional solutes in the blood–> there are foreign invaders!!

25
Q

what is the osmolality gap clinically useful for?

A

screening for alcohol ingestions, screening for ketoacidosis, screening for lactic acidosis

26
Q

when do you find the delta-delta gap?

A

used in patients with HAGMA to determine if there is a coexistent NAGMA or metabolic alkalosis also present

27
Q

how do you calculate the delta gap?

A

calculate anion gap- the normal anion gap; then you have to find the delta HCO3-: normal HCO3- - delta gap

28
Q

what does it mean if the delta HCO3- is around 16?

A

then there is no additional acid-base disorder present

29
Q

what does it mean if the delta HCO3- is greater than 16?

A

then there is a metabolic alkalosis also present in addition to the HAGMA

30
Q

what does it mean if the delta HCO3- is less than 16?

A

then a non-gap metabolic acidosis (NAGMA) is present in addition to the HAGMA

31
Q

what are the two mnemonics for the causes of metabolic acidosis?

A

MUDPILES and GOLDMARK

32
Q

what does MUDPILES stand for?

A 
Methanol
Uremia
Diabetic ketoacidosis 
Propylene glycols
Iron or isoniazid 
Lactic acidosis 
Ethanol/ ethylene glycol
Salicylates
33
Q

What does GOLDMARK stand for?

A 
Glycols
Oxoproline
L-lactic acidosis 
D-lactic acidosis 
Methanol
Aspirin 
Renal failure 
Ketoacidosis (alcoholic, diabetic, starvation)
34
Q

What is the mnemonic for causes of increased osmolarity gaps?

A

ME DIE

35
Q

what are the causes of increased osmolarity gaps? (ME DIE)

A 
Methanol
Ethanol 
Diethylene glycol 
Isopropyl alcohol (rubbing alcohol) 
Ethylene glycol
36
Q

what is the enzyme needed for alcohol metabolism?

A

Alcohol dehydrogenase (ADH)

37
Q

what is the mnemonic for NAGMA?

A

DURHAAM

38
Q

what are the causes of NAGMA (DURHAAM)?

A 
Diarrhea
Ureteral diversion or fistula 
Renal tubular acidosis 
Hyperalimentation 
Acetazolamide 
Addison's disease
Miscellaneous
39
Q

what are the miscellaneous causes of NAGMA?

A

toluene toxicity (glue sniffing), pancreatic fistula, medications

40
Q

what are the various renal tubular defects that can be present that lead to RTA?

A

impaired H+ ion secretion or impaired HCO3- reabsorption

41
Q

What are the different types of renal tubular acidosis and where do they occur?

A

RTA 1: distal RTA
RTA 2: proximal RTA
RTA 4: collecting duct

42
Q

What is occurring in RTA 1?

A

there is decreased net H+ ion secretion in distal tubules and collecting duct

43
Q

what is occurring in RTA type 2?

A

there is decreased HCO3- reabsorption in the proximal tubule

44
Q

What is occurring in RTA type 4 (aka hyperkalemic RTA)?

A

there is decreased aldosterone secretion or aldosterone resistant leading to decreased net H+ and K+ secretion in the collecting duct

45
Q

What is the urine anion gap used for?

A

it is clinically used to differentiate renal from non-renal causes of NAGMA

46
Q

what is the urine anion gap (UAG)?

A

it is a marker of NH4Cl (ammonium chloride) excretion, which indicates proper urine acidification

47
Q

what happens to the urinary ammonium chloride excretion in cases of metabolic acidosis?

A

it should increase

48
Q

how do you calculate UAG?

A

(Urine Na+ Urine K) - Urine Cl

49
Q

what does it mean if the UAG is negative?

A

it indicates appropriate distal nephron urinary acidification

50
Q

what does it mean if the UAG is positive?

A

it indicates inappropriate distal nephron urinary acidification

51
Q

what is urine chloride used as?

A

a surrogate marker of ammonium excretion

52
Q

What are the 3 broad causes of respiratory acidosis?

A

anything that lowers respiratory rate/tidal volume, increases dead space, or worsens airway obstruction; inadequate ventilator settings; increases in CO2 production

53
Q

what could cause an increase in CO2 production?

A

increased carbohydrate diet, hyperthermia, and seizures

54
Q

What are some examples of things that lead to an increased respiratory rate, therefore leading to respiratory alkalosis?

A

pna, PE, pulmonary edema, pneumothorax, pregnancy, sepsis, anxiety

55
Q

what is the relationship between acidosis/alkalosis and serum potassium?

A

acidosis is associated with hyperkalemia and alkalosis is associated with hypokalemia

Renal :') (16 decks)

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