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Acid Base disorders Flashcards

1
Q

what is the percentage of toal body water, intracellular fluid, extracellular fluid?

A

total body water = 60%
ICF = 40%
ECF = 20%

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2
Q

what is a volatile acid & non-volatile acid?

A

volatile acid = carbonic acid
non-volatile acid = non-carbonic

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3
Q

what is the formula for pH?

A

pH = pka + log [HCO3/CO2]

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4
Q

what are other factors that can contribute to pH?

A

Hgb
Plasma
CHONs
PO4s, etc

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5
Q

what is th emost important buffer of the ECF?

A

bicarbonate buffer system

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6
Q

what is the equation of bicarbonate buffer system?

A

CO2 + H2O => H2CO3 => H + HCO3

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7
Q

What is the Henderson-Hasselbach equation?

A

pH = 6.1 + log [HCO3/CO2]

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8
Q

what idoes the numerator & denominator in HH equation represent?

A

numerator = respiratory acid-base disorders
denominator = metabolic acid-base disorder

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9
Q

how do u find the value of H+ if u are given a pH > 7.40?

A

if pH > 7.40

[H+] = 40 x (0.8)^x
[H+] = 40 x (0.8)^1

x = no of tenths above 7.40

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10
Q

how do u find the value of H+ if u are given a pH< 7.40?

A

if pH = 7.20
H = 40 x (1.25)^y
H = 40 x (1.25)^2

y = no of tenths below 7.40

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11
Q

WHat are the 3 important functions of the kidney in managing the net acid secretion?

A
  1. excrete H+ equal to NVA production w/ urinary buffers
  2. Reabsorb filtered HCO3 & ultrafiltrate of plasma
  3. synthesize and excrete ammonium
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12
Q

how much HCO3 is reabsorbed across the glomerulus?

A

4,320 mEq/day

normal HCO3 = 24 GFR = 180L/day 24mEq x 180L/day = 4,320

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13
Q

how much HCO3 is reabsorbed within the tubules?

A

80% in PCT
10% TAL
DT 6%
CCD 4%

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14
Q

How do u form new HCO3?

A
  • PCT produces NH4 from metab of Glutamine
  • TAL reabsorbed NH4
  • accumualtes in the medullary intersititium with NH3
  • CD secrete NH4 & is eliminated in the urine
  • process adds HCO3 in the body
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15
Q

to what does HCO3 production depend on?

A

ability of the kidneys to excrete NH4

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16
Q

what happens to HCO3 if it is not excreted in the urine?

A

ion goes back to circulation -> converted to urea by liver

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17
Q

how do u measure NH4 excretion?

A

using anion gap

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18
Q

what does it indicate if there is a negative anion gap?

A
  • adequate NH4 excreted along w/ HCl
  • kidneys are ok and able to produce HCO3
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19
Q

what does it indicate if there is a positive anion gap?

A
  • renal defect in NH4 productoin & excretion
  • there may be a defect in the tubule
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20
Q

what are the 3 compensatory mechanisms of acid-base disorders?

A
  • ECF & ICF bufering
  • Respiratory
  • renal
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21
Q

what is the main diff betw ECF & ICF buffering?

A

ECF buffering = instantaneous
ICF buffering = takes several mins

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22
Q

what happens in ECF buffering?

A
  • HCO3 is already avail in ECF
  • HCO3, PO4 and plasma proteins buffer 50-70% of NVA and alkali
  • demineralization of bones to help out in acidosis
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23
Q

what happens in ICF buffering?

A
  • movement of H into cells (nonvolatile acids)
  • nonvolatile alkali = movement of H out of the cell
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24
Q

what happens in metabolic acidosis?

A

INC H
DEC pH
INC RR
DEC CO2

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25
what are the renal compensations?
* acidosis = new HCO3 is added to the body * alkalosis = HCO3 appears in the urine
26
what are conditions that have metabolic acidosis?
diabetic ketoacidosis diarrhea renal failure/renal tubular acidosis
27
what happens to renal compensation if blood volume is depleted along with metabolic alkalosis?
* HCO3 is not excreted * kidneys will first try to restore volemia * administer then fluids * restore to euvolemia to correct metabolic alklalosis
28
what are the computations for acute & crhonic respiratory alkalosis?
* Acute = [HCO3] will DEC 0.2mmol/L per mmHg DEC in PCO2 * Chronic = [HCO3] will DEC 0.4mmol/L per mmHg DEC in PCO2
29
what are the computations for acute & crhonic respiratory acidosis?
* Acute = [HCO3] will INC 0.1mmol/L per mmHg INC in PCO2 * Chronic = [HCO3] will INC 0.4mmol/L per mmHg INC in PCO2
30
what are the computations for metabolic acidosis?
pCO2 = (1.5 x HCO3) + 8 +/- 2 OR pCO2 will DEC 1.25mmHg per mmol/L DEC in HCO3 OR pCO2 = HCO3 + 15
31
what are the computations for metabolic alkalosis?
pCO2 will INC 0.7mmHg/mmol/L INC in [HCO3] OR pCO2 will INC 6mmHg per 10mmol/L INC in [HCO3] OR pCO2 = HCO3 + 15
32
How do u diagnose acid-base disorders?
1. obtain ABG & electrolytes simultaneously 2. compare HCO3 on AG & electrolytes to verify 3. calculate anion gap 4. know 4 cauues of 4 AG acidosis (ketoacidosis, lactic acidosis, renal acidosis, toxins) 5. know 2 cauyses of Hyperchloremic or non anion gap acidosis 6. estimate compensatory mechanism 7. compare change in AG & HCO3 8. compare change in Cl w/ change in Na
33
what is the calculation for anion gap?
AG = Na - (HCO3 + HCl)
34
what are the diff interpretations of change in AG/HCO3?
* <0.4 = NAGMA (non anion gap metabolic acidosis) * <0.8 = NAGMA + HAGMA (high anion gap metabolic acidosis * 0.8 - 2.0 = HAGMA * >2.0 = HAGMA + metabolic acidosis
35
what are the causes of High AG acidosis?
* anion albumin * acetoacetate & lactate * INC unmeasured anions/DEC in unmeasured cations
36
what are normal values of Cl & HCO3?
Cl = 106mEq HCO3 = 24mEQ
37
in a high anion gap, what are the levels of Na, Cl, HCO3 and anions?
* Na & Cl = normal * HCO3 = low * anions = high
38
in normal anion gap, hyperchloremia, what are the values of Na, Cl, HCO3, & anions?
* Na & anion = normal * Cl = high * HCO3 = low
39
what is termed as fast & shallow breathing typical of metabolic acidosis?
Kussmaul's respiration
40
what are the effects of metabolic acidosis in CVS, nervous sytem, & glucose levels?
* Glucose = depends on situation if high or low * Nervous sytem = peripheral arterial vasodilation, central venocosntriction, CNS depression * Cardiac system = depressed carediac contractility, arterial vasodilation, pulmonary edema
41
what are causes of non-AG or hyperchloremic acidosis?
* GI bicarbonate loss = diarrhea, drugs, external pancreatic or small bowel drainage, ureterosigmoidostomy * renal acidosis
42
what are the 3 types of RTA?
* RTA 1 (classic/distal) = presents with hypokalemia * RTA 2 (proximal) = presents with hypokalemia * RTA 4 (hyperkalemic) = drug-induced hyperkalmeia
43
what are the 2 types of high AG acidosis, lactic acidosis?
type A = poor tissue perfusion type B = anaerobic disorders
44
what are the diff conditions under type A & B of HAG acidosis, lactic acidosis?
type A = low BP, circulatory insufficiency, severe anemia, mitochondrial enzyme defect & inhibitors type B = malignancies, DM, hepatic or renal failure, severe infections, seizures, AIDS, drugs , toxins, bowel ischemia or infarction
45
what is the tx for lactic acidosis?
* restore good tissue perfusion * acoid vasoonstrictors * alkali therapy in sever acidosis
46
what are management of diabetic ketoacidosis & nonketotic hyperglycemia?
* Insulin * fluid administration * K repletion * alkali
47
what are clinical signs of alcoholic ketoacidosis?
* increase in AG * increase hypophosphatemia * increase hypokalemia * hypomagnesemia
48
what is the common acid bsae disorder in alcoholic acidosis?
mixed acid-base disorder
49
what are the 4 causes of drug/toxin induced acidosis?
* salicylate * ethylene glycol * methanol * toxins
50
what acid-base disorders are present in salicylate ketoacidosis?
* respiratory alkalosis * mixed metabolic acidosis-respiratory alkalosis * pure high AG metabolic acidosis
51
what are the diff tx of Salicylate ketoacidosis?
* vigorous gastric lavage with saline -> activated charcoal to absorb toxin * NAHCO3 per IV for alkaline diuresis
52
what is commonly known as "antifreeze"
ethylene glycol
53
what acid-base disorder is present in ingestion of ethylene glycol?
metabolic acidosis + CNS, heart, lung, and kidney disorders
54
what are the diagnostic signs of ethylene glycol ingestion?
1. high AG acidosis * high osmolar gap * oxalate crystals in urine
55
what are txs for ethylene glycol?
* saline/osmotic diuresis * thiuamine & pyrdoxine supplements * Fomepizole * Hemodilaysis (for kidney failure)
56
what diagnostic signs are seen in methanol poisoning?
* metabolic acidosis + optic nerve & CNS damage * abdominal pain/pancreatitis
57
what is the tx for Metahnol?
same as ethylene glycol acidosis
58
what happens to our kidneys when there is increase in toxins?
advanced renal failure due to poor filtration and reansorption of organic ions
59
what acid-base disorder is present in toxin induced renal failure?
uremic acidosis -> decrease NH4 production/excretion
60
what is the AG & HCO3 lvel of metabolic acidosis?
HCO3 >= 15mmol/L AG =<20mmol/L
61
what are txs for toxin induced renal failure?
* NaHCO3 at 1.0-1.5 mmol/kg/day * conservative vs renal repalcement therapy
62
what are causes of hyperchloremic (nongap) metabolic acidosis?
* diarrhea * renal tubular acidosis
63
what is used to differntiate whether hyperchloremia is caused by diarrhea or renal tubular defect?
urinary anion gap
64
what does it indicate if UAG is negative?
extrarenal cause or diarrhea
65
what does it indicate if UAG is positive?
kidneys
66
what is the levl of HCO3 in RTA?
low & + UAG
67
what is the less common type of RTA?
RTA 2 = reabsorption problem
68
in what type of RTA does Fanconi-like syndrome fall?
RTA 2
69
what type of RTA is more commonly seen?
RTA 1
70
what is the final determinant whethere the urine will be acidic or alkaline?
RTA 1 = acidifaction defect
71
what is RTA 4?
hyporeninemic hypoaldosteronism or lack of aldosterone
72
what are the K levels of RTA 1, 2, & 4?
RTA 1 & 2 = hypokalemia RTA 4 = hyperkalemia
73
what is the cause of metabolic alkalosis?
result of net gain of HCO3 or loss of nonvolatile acid (usually HCl by vomiting) from ECF
74
does metabolic alkalosis occur in assoc w/ other disorders?
yes
75
what are diagnostic features of metabolic alkalosis?
* INC pH * INC serum HCO3 w/ compensatory increase in PaCO2 * hypochloremia * hypokalemia
76
what is an important thing to do with px with metabolic alkalosis?
assess the volume status of the patient
77
what are the diff causes of metabolic alkalosis?
* GIT hydrogen loss * renal hydrogen loss * retention of HCO3 * contraction alkalosis
78
what are diff causes of renal H+ loss?
* diuretic use induces volume contraction * mineralocorticoid excess * posthypercapnic alkalosis
79
what are the diff tx metabolic alkalosis?
* reverse the contraction = efficiency repletion is dependent on the admin of Na with only absorbable ion chloride * saline-responsive alkalosis * saline-resistant * stop the cause of H+ loss

Medicine I (8 decks)

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