Acid Base Disorders

Question 1

Which, lactic acidosis or diabetic ketoacidosis, causes a gap acidosis through tissue hypoxia

Answer 1

Lactic acidosis (type A)

Question 2

pH - 7.30
CO2 - 37
HCO3 - 19
Anion gap - 20

Diagnose me

Answer 2

(20 - 12) / (24 - 19)

8/5 >1 so HAGMA and metabolic alkalosis

(example: patient with DKA gets diarrhea)

Question 3

pH - 7.48
CO2 - 25
HCO3 - 18

Diagnose me

Answer 3

Chronic respiratory alkalosis

CO2 change 10:4 HCO3 change

Question 4

Compare and contract causes of HAGMA and NAGMA

Answer 4

HAGMA:
- Build up of acid in blood stream is bound by HCO3
- Causes: diabetic ketoacidosis, lactic acidosis, ethylene glycol (antifreeze ingestion)

NAGMA:
- Loss of bicarb is compensated by increased resorption of chloride
- Cause: Diarrhea

Question 5

Method of classifying different types of metabolic alkalosis

Answer 5

Test patient response to chloride (saline)

If chloride responsive, urine chloride will be <20 and the initial cause was likely GI, NG suction, diuretics

If chloride unresponsive, urine chloride will be >20 and the initial cause was likely renal or adrenal since the kidneys are not resorbing chloride like they should

Question 6

Severe metabolic alkalosis can lead to this type of breathing

Answer 6

Hypopnea

(body wants to conserve CO2 to make blood more acidic)

Question 7

Delta gap results and what they mean

Answer 7

Delta gap <1 = HAGMA and NAGMA

Delta gap of 1 = Pure HAGMA only

Delta gap >1 = HAGMA and metabolic alkalosis

Question 8

Symptom of metabolic acidosis

Answer 8

Compensatory hyperventilation

Question 9

Respiratory alkalosis is always a disorder of

Answer 9

Hyperventilation

Question 10

Delta gap formula

Answer 10

(Anion gap - 12) / (24 - HCO3)

Question 11

Causes of metabolic alkalosis

Answer 11

GI loss of acid through vomiting or NG tube suction

Intracellular shift of K+/H+ due to hypokalemia

Question 12

Treatments for respiratory alkalosis

Answer 12

Reassurance

Sedation if due to anxiety

(not paper bag breathing)

Question 13

Acute vs chronic causes of respiratory acidosis

Answer 13

Both are pH decreases due to hypoventilation leading to hypercapnia

Acute: Cerebrovascular accident, opioids, Guillain-Barre

Chronic - COPD, Pickwickian, bad diaphragm, ALS

Question 14

pH - 7.23
CO2 - 38
HCO3 - 21

Answer 14

Uncompensated metabolic acidosis

Question 15

pH - 7.32
CO2 - 55
HCO3 - 27

Diagnose me

Answer 15

Acute respiratory acidosis

CO2 change 10:1 HCO3 change