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Medicine I > Acid Base disorders > Flashcards

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
Q

what are the renal compensations?

A
  • acidosis = new HCO3 is added to the body
  • alkalosis = HCO3 appears in the urine
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26
Q

what are conditions that have metabolic acidosis?

A

diabetic ketoacidosis
diarrhea
renal failure/renal tubular acidosis

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27
Q

what happens to renal compensation if blood volume is depleted along with metabolic alkalosis?

A
  • HCO3 is not excreted
  • kidneys will first try to restore volemia
  • administer then fluids
  • restore to euvolemia to correct metabolic alklalosis
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28
Q

what are the computations for acute & crhonic respiratory alkalosis?

A
  • Acute = [HCO3] will DEC 0.2mmol/L per mmHg DEC in PCO2
  • Chronic = [HCO3] will DEC 0.4mmol/L per mmHg DEC in PCO2
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29
Q

what are the computations for acute & crhonic respiratory acidosis?

A
  • Acute = [HCO3] will INC 0.1mmol/L per mmHg INC in PCO2
  • Chronic = [HCO3] will INC 0.4mmol/L per mmHg INC in PCO2
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30
Q

what are the computations for metabolic acidosis?

A

pCO2 = (1.5 x HCO3) + 8 +/- 2
OR
pCO2 will DEC 1.25mmHg per mmol/L DEC in HCO3
OR
pCO2 = HCO3 + 15

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31
Q

what are the computations for metabolic alkalosis?

A

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

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32
Q

How do u diagnose acid-base disorders?

A
  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
Q

what is the calculation for anion gap?

A

AG = Na - (HCO3 + HCl)

34
Q

what are the diff interpretations of change in AG/HCO3?

A
  • <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
Q

what are the causes of High AG acidosis?

A
  • anion albumin
  • acetoacetate & lactate
  • INC unmeasured anions/DEC in unmeasured cations
36
Q

what are normal values of Cl & HCO3?

A

Cl = 106mEq
HCO3 = 24mEQ

37
Q

in a high anion gap, what are the levels of Na, Cl, HCO3 and anions?

A
  • Na & Cl = normal
  • HCO3 = low
  • anions = high
38
Q

in normal anion gap, hyperchloremia, what are the values of Na, Cl, HCO3, & anions?

A
  • Na & anion = normal
  • Cl = high
  • HCO3 = low
39
Q

what is termed as fast & shallow breathing typical of metabolic acidosis?

A

Kussmaul’s respiration

40
Q

what are the effects of metabolic acidosis in CVS, nervous sytem, & glucose levels?

A
  • 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
Q

what are causes of non-AG or hyperchloremic acidosis?

A
  • GI bicarbonate loss = diarrhea, drugs, external pancreatic or small bowel drainage, ureterosigmoidostomy
  • renal acidosis
42
Q

what are the 3 types of RTA?

A
  • RTA 1 (classic/distal) = presents with hypokalemia
  • RTA 2 (proximal) = presents with hypokalemia
  • RTA 4 (hyperkalemic) = drug-induced hyperkalmeia
43
Q

what are the 2 types of high AG acidosis, lactic acidosis?

A

type A = poor tissue perfusion
type B = anaerobic disorders

44
Q

what are the diff conditions under type A & B of HAG acidosis, lactic acidosis?

A

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
Q

what is the tx for lactic acidosis?

A
  • restore good tissue perfusion
  • acoid vasoonstrictors
  • alkali therapy in sever acidosis
46
Q

what are management of diabetic ketoacidosis & nonketotic hyperglycemia?

A
  • Insulin
  • fluid administration
  • K repletion
  • alkali
47
Q

what are clinical signs of alcoholic ketoacidosis?

A
  • increase in AG
  • increase hypophosphatemia
  • increase hypokalemia
  • hypomagnesemia
48
Q

what is the common acid bsae disorder in alcoholic acidosis?

A

mixed acid-base disorder

49
Q

what are the 4 causes of drug/toxin induced acidosis?

A
  • salicylate
  • ethylene glycol
  • methanol
  • toxins
50
Q

what acid-base disorders are present in salicylate ketoacidosis?

A
  • respiratory alkalosis
  • mixed metabolic acidosis-respiratory alkalosis
  • pure high AG metabolic acidosis
51
Q

what are the diff tx of Salicylate ketoacidosis?

A
  • vigorous gastric lavage with saline -> activated charcoal to absorb toxin
  • NAHCO3 per IV for alkaline diuresis
52
Q

what is commonly known as “antifreeze”

A

ethylene glycol

53
Q

what acid-base disorder is present in ingestion of ethylene glycol?

A

metabolic acidosis + CNS, heart, lung, and kidney disorders

54
Q

what are the diagnostic signs of ethylene glycol ingestion?

A
  1. high AG acidosis
    * high osmolar gap
    * oxalate crystals in urine
55
Q

what are txs for ethylene glycol?

A
  • saline/osmotic diuresis
  • thiuamine & pyrdoxine supplements
  • Fomepizole
  • Hemodilaysis (for kidney failure)
56
Q

what diagnostic signs are seen in methanol poisoning?

A
  • metabolic acidosis + optic nerve & CNS damage
  • abdominal pain/pancreatitis
57
Q

what is the tx for Metahnol?

A

same as ethylene glycol acidosis

58
Q

what happens to our kidneys when there is increase in toxins?

A

advanced renal failure due to poor filtration and reansorption of organic ions

59
Q

what acid-base disorder is present in toxin induced renal failure?

A

uremic acidosis -> decrease NH4 production/excretion

60
Q

what is the AG & HCO3 lvel of metabolic acidosis?

A

HCO3 >= 15mmol/L
AG =<20mmol/L

61
Q

what are txs for toxin induced renal failure?

A
  • NaHCO3 at 1.0-1.5 mmol/kg/day
  • conservative vs renal repalcement therapy
62
Q

what are causes of hyperchloremic (nongap) metabolic acidosis?

A
  • diarrhea
  • renal tubular acidosis
63
Q

what is used to differntiate whether hyperchloremia is caused by diarrhea or renal tubular defect?

A

urinary anion gap

64
Q

what does it indicate if UAG is negative?

A

extrarenal cause or diarrhea

65
Q

what does it indicate if UAG is positive?

A

kidneys

66
Q

what is the levl of HCO3 in RTA?

A

low & + UAG

67
Q

what is the less common type of RTA?

A

RTA 2 = reabsorption problem

68
Q

in what type of RTA does Fanconi-like syndrome fall?

A

RTA 2

69
Q

what type of RTA is more commonly seen?

A

RTA 1

70
Q

what is the final determinant whethere the urine will be acidic or alkaline?

A

RTA 1 = acidifaction defect

71
Q

what is RTA 4?

A

hyporeninemic hypoaldosteronism or lack of aldosterone

72
Q

what are the K levels of RTA 1, 2, & 4?

A

RTA 1 & 2 = hypokalemia
RTA 4 = hyperkalemia

73
Q

what is the cause of metabolic alkalosis?

A

result of net gain of HCO3 or loss of nonvolatile acid (usually HCl by vomiting) from ECF

74
Q

does metabolic alkalosis occur in assoc w/ other disorders?

A

yes

75
Q

what are diagnostic features of metabolic alkalosis?

A
  • INC pH
  • INC serum HCO3 w/ compensatory increase in PaCO2
  • hypochloremia
  • hypokalemia
76
Q

what is an important thing to do with px with metabolic alkalosis?

A

assess the volume status of the patient

77
Q

what are the diff causes of metabolic alkalosis?

A
  • GIT hydrogen loss
  • renal hydrogen loss
  • retention of HCO3
  • contraction alkalosis
78
Q

what are diff causes of renal H+ loss?

A
  • diuretic use induces volume contraction
  • mineralocorticoid excess
  • posthypercapnic alkalosis
79
Q

what are the diff tx metabolic alkalosis?

A
  • 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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