Acid Base Disorders

Question 1

Normal Values for :
1. pH
2. pCO2?
3. HCO3-
4. Anion Gap

Answer 1

1. 7.4 (7.35-7.45)
2. 40 mmHg (35-45 mmHg)
3. 24 mEq/L (22-31 mEq/L)
4. 4-12 mEq/L

Question 2

1. if pH < 7.35 whats happening?
2. if pH > 7.45 whats hapenning?
3. What occurs during Respiratory Acidosis ?
4. Metab Acidosis?
5. Respiratory alkalosis
6. Metabolic Alkalosis

Answer 2

1. ACidosis
2. alkalosis
3. Incr pCO2
4. Decr HCO3-
5. DECR PCO2
6. INCR HCO3

Question 3

Clinical Manifestations :
For each , state what happens to the pH, Primary changes, and Signs and sx’s

1. Metab acidosis
2. Metab alkalosis
3. respiratory acidosis
4. Respiratory alkalosis

Answer 3

1. pH down, DECR HCO3 (<22)
   -HYPERventilation, decr card contractility, vasodilation, HYPERKALEMIA , decr catecholamine response
2. incr pH, Incr HCO3 (>26)
   -HYPOVentilation, hypokalemia, arrhythmias
3. decr pH, INCR pCO2 (>45)
   -HA, seizures, alt mental status, coma
4. INCR pH, Decr pCO2 (<35)
   -N/V, alt ment status

Question 4

What does the ANION GAP help us determine the etiology of?

Equation of AG?

Answer 4

1. Metab acidosis
2. AG = Na - (CL+HCO3)

Question 5

Etiologies : Metab Acidosis ****

1. What are some etiologies for high AG (AG >20)?
   MUDPILES
2. Non -AG (AG<12)

Answer 5

1. methanol
   uremia (often a/w renal failure)
   Diabetic Ketoacidosis (DKA)
   Propylene glycol
   -Intoxication or infection
   -lactic acidosis
   -ethylene glycol
   -salicylate
2. Fistula (Pancreatic)
   uteroenteric conduits
   SALINE EXCESS
   Endocrine (HyperParathyroidism)
   -Diarrhea
   -CAI’s (Acetazolamide)
   -Arginine, lysine, chloride
   -RENAL TUBULAR ACIDOSIS
   -Spironolactone

Question 6

Management : Metab Acidosis

1. Correct ___
2. Use of alkali therapy such as ___ can be considered in NON-AG metab acidosis
3. For mild/mod metab acidosis such as pH range ___, can use oral bicarb tabs and oral organic acids that convert to bicarb such as ?
4. What about severe metab acidosis with pH < 7.2 , and hemodynamic instability
5. How do you treat a pt that has DKA due to metabolic acidosis?

Answer 6

1. Primary cause
2. sodium bicarb
3. 7.2-7.35
   -Lactate, acetate, gluconate and citrate
4. IV Sodium bicarb or via renal replacement therapy (RRT)
5. give IV fluids and insulin which lowers potassium

Question 7

Etiologies : METAB ALKALOSIS *****

1. Urine CL > 25 (Resistant)
   H, M, H,M,I
2. Urine CL< 25 (Sensitive)
   G, E, E

Answer 7

1. Hyperaldosteronism
   -Mineralocorticoid excess (Decr K, Decr H, incr Na, incr HCO3)
   -Hypokalemia (Incr HCO3)
   -magnesium depletion
   -inherited diseases w/defective renal Na channels (Liddles Syndromes)
2. GI LOSSES : Vomiting, nasogastric suctioning
   -Extracellular fluid volume or chloride depletion (Diuretic therapy )
   -Exogenous alkali source (Bicarb, citrate, lactate, gluconate, acetate, antacids)

Question 8

Management of Chloride Resistant : (Metab alkalosis)

1. Associated with corticosteroids ?
2. Hypokalemia or hypomagnesemia ?
3. Liddle’s syndrome?
4. Bartter and Gittleman Syndrome?

CHLORIDE Responsive (Metab Alkalosis)

1. Mild cases? (pH 7.45-7.6)
2. If IVF intolerant (HF, cirrhosis)
3. Severe cases (pH > 7.6) ?

Answer 8

1. Decr or change steroid to 1 with less mineralocorticoid activity (FLudro >Hydro>Pred> methylpred> dexa)
2. Correct imbalances
3. Amiloride or triamterene
4. Amiloride or Triamterene, or Spironolactone
5. Normal saline replacement
6. Acetazolamide 500 mg IV/Po X 1
7. HCL solution

Question 9

Etiologies for Respiratory Acidosis *****
AHOCOPT (7)

Managing Respir Acidosis
A. Avoid ____
B. Respiratory therapy like?
C. Identify and treat the ___

Answer 9

1. airway obstruction
2. hypoventilation
3. obesity
4. COPD
5. opioid
6. Pneumo or pulm edema
7. trauma

A. IV Sodium bicarb
B. Nasal cannula, CPAP, BiPAP, mech ventilation
C. underlying cause

Question 10

Respiratory Alkalosis : Etiologies **
1. H,C,P,T, M

Management :
1. Typically ___
2. Identify and treat underlying cause
3. mechanical ___
4. S, A,A

Answer 10

1. Hyperventilation (anxiety , pain)
2. CNS disorders (trauma, enceph)
3. Pulm embolism
4. Tissue hypoxia (Altitude sickness)
5. Mechanical ventilation

Self limiting
Ventilation adjustment
Sedation, anxiolytics , analgesia