Acid-Base Disorders Flashcards
How do you define acedemia?
Low serum pH (less than 7.35)
low serum bicarbonate
(compensation causes compensatory alveolar hyperventilation and a resulting fall in PaCO2
How is H+ secreted by the kidney?
combined with NH3 to become NH4+
or HPO42- becomes H2PO4-
What are some common reasons for increased acid load?
lactic acid
ketoacids (DM, alcohol, starvation)
inorganic acid addition (HCL, NH4Cl)
What are two circumstances where NH4+ production in response to an increased acid load cannot occur?
- renal failure
- distal renal tubular acidosis (Type I)
There are only two routes of bicarbonate loss from the body. What are they?
- diarrhea
- urethra - tubular dysfunction
How do you calculate anion gap?
AG = Na - (Cl + HCO3-)
Figge correction = AG + [(4.4-Albumin) x 2.5]
What is a normal anion gap?
10-12
What does it mean if anion gap is high?
AG metabolic acidosis
What is the differential diagnosis for anion gap metabolic acidosis?
CUTE DIMPLES
Citrate
Uremia
Toluene
Ethanol
Diabetic ketoacidosis
Iron
Methanol
Paraldehyde
Lactate
Ethylene glycol
Salicylate
Which three causes of anion gap metabolic acidosis are NOT ingestion related?
- uremia
- ketoacidosis
- lactic acidosis
What stages of CKD are likely to be anion gap metabolic acidosis?
Stages 4-5
retention of hydrogen ion and sulfate anion due to marked reduction in nephrons and GFR
DKA causes anion gap acidosis how?
- 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
What are the steps to diagnosing acid-base disorders?
- Is the patient acidemic or alkalemic?
- is the primary disorder respiratory or metabolic?
- For respiratory, process acute or chronic?
- for metabolic acidosis, is an anion gap present?
- Is it a mixed disorder?
- Is there appropriate compensation for the disturbance?
What’s a normal arterial pCO2?
36-44
What’s a normal aterial bicarb?
22-26