Acid-Base Disorders Flashcards

1
Q

How do you define acedemia?

A

Low serum pH (less than 7.35)

low serum bicarbonate

(compensation causes compensatory alveolar hyperventilation and a resulting fall in PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is H+ secreted by the kidney?

A

combined with NH3 to become NH4+

or HPO42- becomes H2PO4-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some common reasons for increased acid load?

A

lactic acid

ketoacids (DM, alcohol, starvation)

inorganic acid addition (HCL, NH4Cl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are two circumstances where NH4+ production in response to an increased acid load cannot occur?

A
  1. renal failure
  2. distal renal tubular acidosis (Type I)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

There are only two routes of bicarbonate loss from the body. What are they?

A
  1. diarrhea
  2. urethra - tubular dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you calculate anion gap?

A

AG = Na - (Cl + HCO3-)

Figge correction = AG + [(4.4-Albumin) x 2.5]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a normal anion gap?

A

10-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does it mean if anion gap is high?

A

AG metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the differential diagnosis for anion gap metabolic acidosis?

CUTE DIMPLES

A

Citrate

Uremia

Toluene

Ethanol

Diabetic ketoacidosis

Iron

Methanol

Paraldehyde

Lactate

Ethylene glycol

Salicylate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which three causes of anion gap metabolic acidosis are NOT ingestion related?

A
  1. uremia
  2. ketoacidosis
  3. lactic acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What stages of CKD are likely to be anion gap metabolic acidosis?

A

Stages 4-5

retention of hydrogen ion and sulfate anion due to marked reduction in nephrons and GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DKA causes anion gap acidosis how?

A
  • insulin deficiency causes low glucose levels in the cell, leads to free fatty acid breakdown, which leads to acetone production
  • glucagon excess causes free fatty acid conversion to ketoacids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the steps to diagnosing acid-base disorders?

A
  1. Is the patient acidemic or alkalemic?
  2. is the primary disorder respiratory or metabolic?
  3. For respiratory, process acute or chronic?
  4. for metabolic acidosis, is an anion gap present?
  5. Is it a mixed disorder?
  6. Is there appropriate compensation for the disturbance?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What’s a normal arterial pCO2?

A

36-44

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What’s a normal aterial bicarb?

A

22-26

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Winter’s formula used for?

A

Provides a measure of the expected respiratory compensation to a metabolic acidosis

Expected pCO2 = [1.5 x (HCO3)] +8 +/-2

metabolic acidosis ONLY

17
Q

how do you interpret the results of Winter’s formula?

A

If the pCO2 is below expected, then respiratory alkalosis is present also

If the pCO2 is higher than the expected, respiratory acidosis is present also

18
Q

citrate anion gap metabolic acidosis is usually due to one or more of these three things?

A

transfusion

trauma

anticoagulation

19
Q

What is Type 1 Renal Tubular Acidosis?

A

Defect in tubule causing altered secretion of H+ as NH4+ with GFR usually preserved

Impaired apical H+-ATPAse

decreased carbonic anhydrase activity

increased permeability to H+

Overall, less net acid excretion

20
Q

When bicarbonate is lost to diarrhea, sodium levels ____ and Cl- ____

A

Stay the same

Cl- in the serum increase

21
Q

What is proximal renal tubule acidosis (Type 2)?

A

An inabilty to reabsorb HCO3- in the proximal tubule, leading to loss of bicarbonate in the urine unless distal can compensate

22
Q

What are the major clinical manifestations of metabolic acidosis?

A
  • Respiratory - increased ventilation
  • CV - decreased contractility, arrhythmias
  • GI - nausea/vomiting, abdominal pain, diarrhea
  • MSK - weakness, osteomalacia, osteopenia, hypercalcuria
  • CNS - lethargy, coma
  • Kids - impaired bone growth, anorexia, listlessness
23
Q

What causes metabolic alkalosis?

A

progessive loss of acids

(H+ with increased HCO3- generation)

24
Q

What are some common caues of metabolic alkalosis?

A

GI

  • vomiting
  • nasogastric suction
  • villous adenoma

Renal

  • diuretics
  • inherited transport defects
  • mineralcorticoid excess
  • posthypercapnia
25
Q

What is contraction alkalosis?

A

when fluid loss creates alkalosis by increasing bicarbonate in the serum.

26
Q
A