Acid Base Disorders

Question 1

Formula for anion gap

Answer 1

Sodium - (chloride + bicarb)

Question 2

Normal range for anion gap

Answer 2

10 +/- 2

Question 3

Unmeasured anions

Answer 3

proteins, sulfate, phosphate, organic anions

Question 4

Unmeasured cations

Answer 4

potassium, magnesium, calcium

Question 5

Formula for albumin adjustment to anion gap

Answer 5

(4-albumin) * 2.5

Question 6

Winter’s formula for metabolic acidosis

Answer 6

1.5(bicarb) + 8 +/- 2

Question 7

Generic respiratory acid base compensation formula

Answer 7

(x * (change in bicarb/10)) + 24

Question 8

Mnemonic for acid base compensation bases

Answer 8

1,2,4,5, 10, 15

Acute acidosis
Acute alkalosis
Chronic acidosis
Chronic alkalosis
Metabolic acidosis
Metabolic alkalosis

Question 9

4 things that cause metabolic alkalosis due to increased cations

Answer 9

Parenteral nutrition

Massive blood transfusion

Lactated ringers

Sodium citrate

Question 10

4 thing that cause metabolic alkalosis due to decreased chloride if urinary chloride is < 10

Answer 10

Vomiting

NG suctioning

Diuresis

Post-Hypercapnia

Question 11

4 things that cause metabolic alkalosis due to decreased chloride if the urinary chloride is > 20

Answer 11

Hyperaldosteronism (primary or secondary)
Hypokalemia
Barrter’s
Gitelman’s

Question 12

Delta gap formula

Answer 12

ΔAG/Δbicarb

Question 13

Delta gap > 1 signifies what

Answer 13

concurrent metabolic alkalosis

Question 14

Delta gap < 1 signifies what

Answer 14

concurrent non-anion gap metabolic acidosis

Question 15

Alternative formula for delta gap

Answer 15

ΔAG + bicarb

Result is measured bicarb before the anion gap

Question 16

GOLDMARK pneumonic for metabolic acidosis causes

Answer 16

Glycols (ethylene or propylene)
Oxoproline (Chronic tylenol ingestion)
L-lactate
D-lactate (gut bacteria make in people with short guts, GI surgery, or poor absorption)
Methanol
Aspirin
Renal failure
Ketoacidosis

Question 17

Source of oxoproline as a cause of anion gap acidosis

Answer 17

Malnutrition in chronic tylenol use

Question 18

Causes of D lactate accumulation

Answer 18

Short bowel syndrome and carb heavy meals

Large amount of propylene glycol ingestion

DKA

Question 19

6 common drugs as sources for propylene glycol when given IV

Answer 19

Bactrim

Diazepam

Etomidate

Lorazepam

Nitroglycerin

Phenytoin

Question 20

HARDUP pneumonic for non-anion gap metabolic acidosis causes

Answer 20

Hyperalimentation

Acetazolamide

RTA

Diarrhea

Uretero-bowel fistula

Pancreatic fistula

Question 21

Formula for urinary anion gap

Answer 21

(Sodium + Potassium) - Chloride

Question 22

Normal urinary anion gap range

Answer 22

-10 to +10

Question 23

Normal range for urinary anion gap in the presence of acidosis

Answer 23

< -10

Question 24

3 causes of extremely low or negative anion gap

Answer 24

very high K, Mg, or Ca

Lithium

Multiple myeloma (paraproteins)