Acid-Base disorders Flashcards

1
Q

Acidosis vs acidemia

A

acidemia is a blood pH<7.36

Acidosis is the clinical process that leads to a decreased blood pH (does not always succeed in creating acidemia)

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2
Q

Ventilation

A

process that brings inhaled air tot he alveoli (does not include the process of gas exchange)
*influences pCO2, not pO2

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3
Q

Minute ventilation

A

rate by which air reaches alveoli
L/min
=RRxTV

reflected by hyper or hypoventilation

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4
Q

General causes of met. acidosis

A

over production or accumulation of acid
loss of base
under excretion of acid

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5
Q

General causes of met. alk.

A

loss of acid

underexcretion of base

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6
Q

Chronic respiratory disorders

A
fully compensated (pH is close to normal) 
likely 2-3 days old
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7
Q

sub-acute or acute respiratory disorders

A

occur w/in 2 days of initiation of disorder
uncompensated (resulting acidemia or alkalemia)
or paritally compensated
**ability to compensate depends on chronicity

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8
Q

compensation for metabolic disorders

A

can be fully or partially compensated at time of presentation (depending on amount of acid/alkalemia and LUNG FUNCTION)

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9
Q

Causes of respiratory acidosis

A
Hypoventilation: 
decreased RR (decreased drive- drugs, coma stroke)
decreased TV (NMJ disorders, kyphoscoliosis, airway obstruction, COPD, OSA)
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10
Q

High AG metabolic acidosis

A
Methanol
uremia
DKA
paraldehyde
infection, iron, isoniazide
lactic acidosis 
Ethylene glycol, ETOH
Salicylates, KA
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11
Q

uremic acidosis

A

when renal function is severely decreased ( decreased excretion of H+, decreased bicarb reabs )

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12
Q

lactic acidosis

A

anaerobic metabolisms (hypoxemia, circ failure, vessel bloackage, anemia=decreased muscle perfusion
meds:
metformin, HIV meds, Isoniazide

liver failure, thiamine deficiency, sepsis, seizures

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13
Q

DKA

A

increased lipolysis d/t lack of insulin
increases production of ketones
associated with hyperglycemia
more often of type I DM (presentaiton)

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14
Q

alcoholic ketoacidosis

A

idiopathic increase in ketone production in the liver after large ETOH consumption, normal blood glucose
high osmolar gap (>10)

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15
Q

Osmolar gap

A

difference bw measure serum Osm and calculated serum osm
calculated=2(Na)+(Glu/18)+(BUN/2.8)

should =ETOH leve/4.6
used to Identify other alcohols

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16
Q

ethylene glycol

A
found in antifreeze
metabolites are toxic 
increases OG 
calclium oxalate crystals are often found in urine 
can cause ARF
17
Q

Salicylate posioning

A

usually a result of OD
may cause metabolic acidosis and/or respiratory alkalosis

hemorrhage, fever, nausea, vomiting, tinnitus, edema

18
Q

Causes of normal AG (hyperchloremic) acidosis

A

Diarrhea
decreased renal bicarb reabs (CAi) or RTA
increased anion intake (parenteral feeding)
large amount of NaCl consumption

19
Q

Renal Tubular Acidosis type I

A

decreased H+ excretion in CD
alkaline urine and acidic serum

increased Ca excretion and decreased citric acid concentration leading to kidney stone formation**

increase K loss= hypokalemia

20
Q

RTA type II

A

proximal
defects in bicarb reabs= decreases serum pH and inc urine pH
increases Ca in urine, but normal citrate= stones are rare
hypokalemia
distal tubules work, so you are still able to acidify urine later
acidic urine

21
Q

RTA IV

A

occurs in pt with moderate CRF

lack of ald or ald resistance
decreased K+ excretion= hyperkalemia
decreased H+ excretion= acidmeia
acidic urine

22
Q

Urinary anion gap

A

used to differentiate bw renal (RTA) and extrarenal (diarrhea) causes of acidosis

Urine (Na+K)-Cl-

23
Q

negative urine anion gap

A

Extra renal loss
d/t high levels of unmeasured NH4+
(excretion of NH4 by normal kidneys is compensatory mechanisms)

24
Q

Positive or non-existent uAG

A

renal loss

d/t low levels of NH4 and high levels of HCO3-

25
causes of respiratory alkalosis
hyperventilation | acute: pain, anxiety, salicylate OD, fever, hypoxia)
26
metabolic alkalosis
vomiting, NG suction increased bicarb reabs (dehydration, diuretics) hyperaldosteronism (hypokalemia) recent correction of chronic resp acidosis
27
clinical manifestations of metabolic acidosis
Kussmal respirations nausea and vomiting arrhythmia, hypotension confusion, lethargy, coma
28
Respiratory acidosis- clinical
ineffective respirations arrhythmias, hypotension confusion, lethargy, coma
29
metabolic alkalosis
``` decreased respiration = hypoxia paresthesia carpopedal spasm confusion seizures dizziness coma ```
30
respiratory alkalosis
hyperventilation paraesthesia dizziness