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Renal II > Acid-Base disorders > Flashcards

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
Q

causes of respiratory alkalosis

A

hyperventilation

acute: pain, anxiety, salicylate OD, fever, hypoxia)

26
Q

metabolic alkalosis

A

vomiting, NG suction
increased bicarb reabs (dehydration, diuretics)
hyperaldosteronism (hypokalemia)
recent correction of chronic resp acidosis

27
Q

clinical manifestations of metabolic acidosis

A

Kussmal respirations
nausea and vomiting
arrhythmia, hypotension
confusion, lethargy, coma

28
Q

Respiratory acidosis- clinical

A

ineffective respirations
arrhythmias, hypotension
confusion, lethargy, coma

29
Q

metabolic alkalosis

A 
decreased respiration = hypoxia 
paresthesia 
carpopedal spasm 
confusion 
seizures 
dizziness 
coma
30
Q

respiratory alkalosis

A

hyperventilation
paraesthesia
dizziness

Renal II (7 decks)

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