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RENAL II Exam 3 > Acid-Base Disorders > Flashcards

Acid-Base Disorders Flashcards

1
Q

Respiratory acidosis/alkalosis

A

pH and pCO2 go opposite directions

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2
Q

Metabolic acidosis/alkalosis

A

pH and bicarb go same direction

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3
Q

Acute respiratory acid/base disorder

A

Uncompensated

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4
Q

Chronic respiratory acid/base disorder

A

Totally compensated

Develop 2-3 days before presentation

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5
Q

Anion gap

A

Na - bicarb - Cl

Normal is 10
Don’t forget glucose

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6
Q

High anion gap

A

Normochloremic acidosis

Methanol
Uremia
DM
Paraldehyde
Infection
Lactic acid
Ethanol
Salicylates
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7
Q

Normal anion gap

A

Hyperchloremic acidosis (compensate for lost bicarb)

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8
Q

Uremic acidosis

A

Renal function severely decreased

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9
Q

Lactic acidosis

A

Anaerobic metabolism: hypoxemia, heart failure, peripheral blockage, anemia
Sepsis
Liver failure
Some meds

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10
Q

Ethanol high OG

A

Should equal ethanol level/4.6

Otherwise look for other alcohols

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11
Q

OG

A

2(Na) + Glucose/18 + BUN/2.8

Should equal 10 or less

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12
Q

Normal AG Metabolic Acidosis

A

Diarrhea
RTA or diuretics
Increase NaCl - volume expansion

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13
Q

RTA Type 1

A

Distal
Decreased H excretion
Body pH decrease, urine pH increase

Increased Ca excretion -> stones
Increased K excretion -> hypokalemia

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14
Q

RTA Type 2

A 
Proximal
High excretion of bicarb -> low body pH
Still able to acidify urine distally
Lose Ca but no stones
Hypokalemia
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15
Q

RTA Type 4

A

Chronic renal failure
Decreased aldosterone or aldosterone resistance

HYPERkalemia

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16
Q

Urinary Anion Gap

A

Na + K - Cl

17
Q

Negative U AG

A

Extrarenal

Kidney still able to compensate with increased NH4+ secretion

18
Q

Positive U AG

A

RTA

Low NH4+ and high bicarb

19
Q

Step 1

A

Look at pH

20
Q

Step 2

A

Metabolic vs Respiratory
Does bicarb follow pH = metabolic
Opposite = respiratory

21
Q

Step 3

A

Compensation?
Metabolic - look to see if pH is normal
Respiratory - bicarb should change 5 for every 10 CO2

22
Q

Step 4

A

Anion gap
Na - bicarb - Cl

**Account for glucose
Add 1 for every 100 above 100

23
Q

Step 5

A

Delta-delta gap if anion gap

AG-10 / 24-bicarb

1-1.6 = pure metabolic acidosis
1.6 = concomitant metabolic alkalosis
24
Q

Step 6

A

If metabolic look at respiratory to see if additional process exists

CO2 bicarb opposite directions? additional problem

25
Q

Step 7

A

Refer back to clinical picture

26
Q

Cause of respiratory acidosis

A 
From decreased RR:
Decreased respiratory drive
Drugs
Coma
Stroke
From decreased Tidal Volume:
Neuro-muscular disorders
Severe kyphoscoliosis
Airways obstruction
COPD
Obstructive sleep apnea/Obesity
27
Q

Cause of high AG metabolic acidosis

A 
Methanol
Uremia (End Stage Renal Disease)
Diabetic ketoacidosis
Paraldehyde
Infection, Iron, Isoniazide
Lactic acidosis
Ethylene glycol (antifreeze), alcohol
Salicylates, starvation ketoacidosis
28
Q

Normal AG metabolic acidosis

A

Diarrhea or Ileal drainage with stoma/bypasses
- Due to loss of HCO3
- Except for Chloride wasting diarrhea with villous adenoma
Decrease reabsorption of HCO3 by renal tubules (therefore increased loss)
- Renal Tubular Acidosis
- Due to diuretics ( carbonic anhydrase inhibitors [CAI])
Increase in anion intakes
- Parenteral nutrition
Large amount of NaCl (expansion acidosis)
- Due to dilution of the bicarbonate and to decreased renal bicarbonate reabsorption as a result of volume expansion

29
Q

Cause of respiratory alkalosis

A 
Usually acute
Pain
Anxiety
Salicylates overdose
Fever
Sepsis
Hypoxia from some pulmonary disorders
CHF
Pneumonia
PE
Mild asthma
Mechanical ventilation
30
Q

Metabolic alkalosis

A

Vomiting/NG suction
- Due to lose of hydrochloric acid
Contraction alkalosis due to increased HCO3- reabsorption
- Dehydration
- Diuresis (with diuretics other than CAI)
Hypokalemia
- Due to resulting increased mineralocorticoid secretion
Recent correction of chronic respiratory acidosis
- Due to recent metabolic compensation.

RENAL II Exam 3 (12 decks)

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