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CNSC combines > Acid Base Disorders > Flashcards

Acid Base Disorders Flashcards

1
Q

Compensation for a metabolic disorder occurs via the __ and takes approximately __ hours

A

Lung: 12-24 hours

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2
Q

During acidosis, serum potassium

A

increases

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3
Q

During alkalosis, serum potassium

A

decreases

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4
Q

a patient with nasogastric suctioning output exceeding 2L a day is likely to manifest

A

metabolic alkalosis

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5
Q

acidemia

A

pH <7.35

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6
Q

alkalemia

A

pH >7.45

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7
Q

normal blood pH range

A

7.35-7.45

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8
Q

pCO2 normal range

A

35-45

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9
Q

normal bicarbonate range

A

23-25

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10
Q

how to correct metabolic acidosis with parenteral nutrition ?

A

increase acetate

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11
Q

PN metabolites that are acidic

A

arginine, lyseine, histidine, methionine, cysteine

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12
Q

Metabolic acidosis is associated with _____kalemia

A

hyperkalemia ; correction of metabolic acidosis re distributes potassium into the intracellular space to correct hyperkalemia

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13
Q

when a patient is hyperkalemic, what can be given to correct it?

A

bicarbonate as the body is in a state of acidosis

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14
Q

Decrease pH, Increased PCO2, Normal Bicarb indicates which acid base disorder

A

respiratory acidosis

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15
Q

How to correct respiratory acidosis in PN

A

avoid overfeeding to prevent excessive CO2 production , less carbohydrate

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16
Q

Causes of respiratory acidosis

A

HYPOventilation, sleep apnea, pneumothorax, COPD, ARDS, hypophosphatemia

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17
Q

Causes of respiratory alkalosis

A

HYPERventilation (lost all your CO2), anxiety, pneumonia, high altitude, catecholamines (compromised lung function)

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18
Q

Normal Anion Gap

A

10-12

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19
Q

Causes of normal anion gap metabolic acidosis

A

providing high amounts of chloride in blood (ie IVF)
Bicarbonate loss from high output fistula or ileostomy or excessive diarrhea
Impaired renal function
D-Lactic acidosis

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20
Q

What metabolites are used to calculate Anion Gap?

A

Sodium - Chloride + Bicarb

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21
Q

what are causes of high anion gap metabolic acidosis

A

renal failure, thiamine deficiency (build up of lactate), ketoacidosis, SIBO, diuretic use

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22
Q

If HCO3 and pH move in the same direction it is a _____ disorder

A

metabolic disorder

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23
Q

If PCO2 and pH move in opposite directions it is a ____ disorder

A

respiratory disorder

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24
Q

First line of defense in acid base imbalance

A

Buffers

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25
Q

Second line of defense in acid base imbalance

A

Lungs

26
Q

Primary buffer in the body

A

bicarbonate

27
Q

a mixed acid base disorder occurs when pCO2 and HCO3 move in the ____ direction (s)

A

Opposite

28
Q

a simple acid base disorder occurs when pCO2 and HCO3 move in the ______direction (s)

A

Same

29
Q

How to alter PN in the setting of respiratory alkalosis

A

None

30
Q

In respiratory acidosis, pCO2 _____ and pH ____

A

increases, decreases

31
Q

pH and hydrogen ions move in ___ direction (s)

A

Opposite

32
Q

In respiratory alkalosis, pCO2 ___ and pH ___

A

decreases, increases

33
Q

In metabolic acidosis HCO3 ___ and pH ___

A

decreases, decreases

34
Q

What can you alter in PN in the setting of metabolic acidosis

A

Increase acetate

35
Q

acidic IVF solutions

A

D5W and D5w 1/2 NS

36
Q

In metabolic alkalosis HCO3 ___ and pH ___

A

increases, increases

37
Q

IVF treatment of metabolic alkalosis

A

Isotonic saline + KCl

38
Q

During acidosis, hydrogen ions are prominent in the serum. In order to correct the acidosis, Hydrogen ions are pumped _____ the cell, in exchange for ____ which exits the cell. Therefore the patient becomes hyper______

A

into the cell, potassium, hyperkalemic

39
Q

During alkalosis potassium moves _______ the cell while hydrogen ions move ____ of the cell. Therefore the patient becomes hypo_____

A

into the cell, out of the cell, hypokalemic

40
Q

Case: a 42 year old male is admitted with dizziness and weakness. He has a normal blood pressure of 120/80 mmHg while sitting but a low blood pressure while standing (100/64 mmHg) . This suggests orthostatic hypotension. He has had a history of vomiting. Sodium is 129, Potassium is 2.5, chloride is low, bicarbonate is 58, Creatinine is 1.9, BUN is 32, pH is 7.52, pCO2 is 63, pO2 is 68. What disorder is this? What is the cause? What is the expected compensation? What is the proposed treatment?

A

Metabolic Alkalosis caused by loss of hydrochloric acid from the stomach due to vomiting, it is expected that he will decrease his respiratory rate to increase is concentration of PCO2 (hypo ventilate). He can be treated with Normal saline with KCl as potassium is also low, Normal saline is an acidic IVF solution.

41
Q

Case: a 31 year old male is admitted with abdominal pain and weakness. He has a respiratory rate of 24 breaths per minute (normal is 13-16) and has a history of chronic IV drug use. His sodium is 136, potassium of 5.1, chloride of 100, HCO3 of 14, creatinine of 10, BUN of 120, pH of 7.28, pCO2 of 30 , pO2 of 100 and HCO3 13. What disorder is this? What is the cause? What is the expected compensation? What is the proposed treatment?

A

Metabolic acidosis caused by kidney failure. It is expected that his respiratory rate will increase to get rid of acidic CO2 in order to compensate (hyperventilation). Treatment would be dialysis, NaHCO3

42
Q

total body water for an adult male is __%

A

60%

43
Q

total body water for females is __%

A

50%

44
Q

which conditions would increase a person’s fluid requirements

A

ileostomy, high output fistula, fever

45
Q

the older you are the ____ muscle mass you have there fore less% body water

A

lower

46
Q

functions of water in the body

A

metabolic functions
maintains temperature
circulatory function

47
Q

if the abnormal accumulation of fluid occurs in the ICF compartment or body cavities, the following is most likely to occur

A

edema

48
Q

the component of plasma that is the principal determinant of colloid oncotic pressure

A

albumin

49
Q

the number of osmotically active particles per KG of solvent is known as

A

osmolality

50
Q

the body’s normal osmolality range

A

290-310 mOsm/L

51
Q

the direction and extent of water movement between fluid compartments is determined by the

A

osmolality

52
Q

during osmosis, fluids will shift from an area of lower concentration to an area of higher concentration until the water by

A

osmosis

53
Q

in addition to osmosis the regulation of body fluid compartments also occurs via (3 items)

A

diffusion, filtration and sodium potassium pumps

54
Q

which organs maintain the composition and volume of body fluid (6)

A

heart, lungs, kidneys, pituitary glands, adrenal gland, parathyroid gland

55
Q

As ADH increases, water retention _____

A

increases

56
Q

the majority of sensible water losses occur via

A

urine

57
Q

the majority of insensible losses of fluid come from the _____ and _____

A

skin and lungs

58
Q

third spacing, polyuria, and excessive GI losses are potential losses of

A

fluid

59
Q

3 potential causes of fluid overload include

A

heart failure, cirrhosis, steroid therapy

60
Q

estimated fluid needs for patients in critical illness and sepsis

A

30-40mL/kg/day

61
Q

a patient getting PN that provides NaCl 50mEq/L, KCl 20mEq/L, K Phos 30mEq/L with lab values Na 140, K 4.0, Cl 119, CO211, what is an appropriate adjustment for this PN

A

Change NaCL to Na acetate, add acetate

62
Q

in providing PN to a patient with metabolic alkalosis, the clinician should pay careful attention to the provision of salts as

A

acetate

CNSC combines (9 decks)

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