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CPR II Exam 3 > Acid-Base Disorders > Flashcards

Acid-Base Disorders Flashcards

1
Q

What is the normal range for arterial pH?

Intracellular pH is maintained in what range?

A
  1. 35-7.45
  2. 0-7.3
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2
Q

Many extracellular and intracellular buffer systems maintain the body’s pH. What is the most important buffer system?

A

Bicarbonate buffer system

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3
Q

As HCO3 increases, pH does what?

As PCO2 increases, pH does what?

A

pH increases

pH decreases

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4
Q

Where is carbonic anhydrase found?

A

present in the lung alveoli and renal tubular epithelial cells

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5
Q

Lungs regulate pH by controlling the concentration of what?

Increase RR causes CO2 to (increase or decrease)?

Decrease RR causes CO2 to (increases or decrease)?

A

PCO2

increase in RR=increases in CO2 blown off

decrease in RR=decreases in CO2 blown off

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6
Q

The kidneys regulate pH by excreting what?

A

either an acidic or alkaline urine

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7
Q

A low serum HCO3 indicates what disturbance?

A high serum HCO3 indicates what disturbance?

A

Metabolic Acidosis

Metabolic alkalosis

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8
Q

A high PCO2 indicates what disturbance?

A low PCO2 indicates what disturbance?

Respiratory disturbances can be qualified how?

A

Respiratory Acidosis

Respiratory Alkalosis

Either acute or chronic

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9
Q

What are the two flavors or metabolic acidosis?

A

high anion gap metabolic acidosis

normal anion gap metabolic acidosis

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10
Q

What are the two flavors of metabolic alkalosis?

A

Saline-responsive (hypovolemia or contraction alkalosis)

Saline-Non-Responsive (euvolemia or hypervolemia)

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11
Q

If the kidney caused acidosis/alkalosis, what organ compensates?

If the lung caused acidosis/alkalosis, what organ compensates?

A

The lung!

The kidney!

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12
Q

Metabolic acidosis with a decrease in HCO3 will be compensated with what disturbance?

A

Compensated with respiratory alkalosis

(decreased PCO2, increased RR)

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13
Q

Metabolic alkalosis (increased HCO3) will be compensated with what disturbance?

A

Compensated by respiratory acidosis

(increased PCO2 and decreased RR)

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14
Q

Respiratory acidosis (increased PCO2) will be compensated by what disturbance?

A

Compensated by metabolic alkalosis

(increased HCO3)

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15
Q

Respiratory alkalosis (decreased PCO2) will be compensated by which disturbance?

A

compensated by metabolic acidosis

(decreased HCO3)

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16
Q

For every 10mmHg increase in pCO2, HCO3 should increase by ___ in acute and ___ in chronic respiratory acidosis

A

acute: 1
chronic: 3.5

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17
Q

For every 10mmHg decrease in PCO2, HCO3 should decrease by ___ in acute and ___ in chronic respiratory alkalosis

A

acute: 2
chronic: 5

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18
Q

how many acid-base disturbances can be present at once?

A

three

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19
Q

What are the four steps of determining an acid-base disturbance?

A
  1. determine if it is acidosis or alkalosis
  2. determine if the primary disturbance is metabolic or respiratory
  3. if metabolic acidosis, calculate anion gap
  4. calculate appropriate compensation for primary acid base disorder
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20
Q

If metabolic acidosis is present, what three things should be considered?

A
  1. if hypoalbunemia present, calculate corrected anion gap
  2. if HAGMA present, calculate osmolar gap
  3. if HAGMA present, consider delta-delta gap calculation
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21
Q

If the primary acid-base disorder is compensated appropriately, is there a simple or mixed AB disorder?

A

Simple acid-base disorder

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22
Q

If the primary acid-base disorder is not compensated, is there a simple or mixed AB disorder?

A

Mixed acid-base disorder

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23
Q

What is the normal range for pH?

A

7.35-7.44

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24
Q

What is the normal HCO3?

A

24

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25
What is the normal PCO2?
40
26
What is the normal anion gap?
12
27
What is the normal osmolality gap?
10
28
What is the formula for anion gap? What is anion gap used to determine?
Na-(HCO+Cl) Normal AG is 12+/-2 HAGMA vs. NAGMA
29
If HAGMA is present, calculate the osmolality using the following formula: Find the olsmolar gap how?
2(Na) + (Glucose/18) + (BUN/2.8) normal: 275-290 gap= measured serum osmolality-calculated serum osmolality normal: \<10
30
If anion gap is \>20, what is this highly suspicious for?
Alcohol ingestion | (likely seen with HAGMA)
31
What is delta-delta gap used for?
Used in patients with HAGMA to determine if there is a coexisiting NAGMA or metabolic alkalosis present
32
What are the GOLDMARK causes of HAGMA?
Glycols Oxyproline L-Lactic acidosis D-Lactic acidosis Methanol Aspirin Renal failure Ketoacidosis
33
Which cause of acidosis is commonly seen in women who are malnourished or critically ill? Diagnosed how? Treated how?
Pyroglutamic (5-oxoproline) acidosis Diagnosed via urinary organic acid screen Stop Tylenol; Give IVF and NAC
34
What are the causes of increased osmolar gap?
Methanol Ethanol Dietheylene Glycol Isopropyl Alcohol Ethylene glycol Propylene glycol Ketoacidosis/lactic acidosis
35
Methanol metabolizes to formic acid which can cause which aberration? Ethylene glycol metabolizes to oxalic acid which can cause which aberration?
blindness Renal failure
36
What are the DURHAAM causes of NAGMA?
**Diarrhea** ureteral diversion or fistula **renal tubular acidosis** hyperalimentation acetazolamide addison's disease Misc.
37
When net acid excretion by the kidneys is impaired resulting in a NAGMA without any s/s of AKI, what is the likely diagnosis?
Renal Tubular Acidosis
38
What is RTA 1?
results from decreased net H ion secretion in distal tubules and CD
39
What is RTA 2?
results from decreased HCO3 reabsorption in the proximal tubules
40
What is RTA 4?
results from decreased aldosterone secretion or aldosterone resistance
41
IF RTA is suspected and hypokalemia is present with proximal tubular dysfunction (AA, glucose, bicarb in urine) what is the diagnosis?
Type 2 RTA urine anion gap will be negative
42
If RTA is suspected and hypokalemia is present without proximal tubular dysfunction, what is the diagnosis?
Type 1 RTA urine anion gap will be positive
43
If RTA is suspected and hyperkalemia is present, what is the diagnosis?
Type 4 RTA urine anion gap will be + most common type, often seen with DM2 or CKD
44
What is the urine anion gap used for? How is it calculated?
used to differentiate **renal from non-renal** causes of NAGMA NH4Cl excretion indicates urinary acidifcation and is UAG is a **surrogate marker** of NH4 excretion via NH4Cl UAG=(urineNa + UrineK) - UrineCl if *negative*-appropriate urinary acidification if *positive-*inappropriate urinary acidification
45
Along the nephron, as H ions are secreted, what is reabsorbed at a 1:1 ratio?
HCO3
46
What is the etiology for RTA 2?
common cause in children is cystinosis common cause in adults is Fanconi Syndrome caused by Multiple Myeloma
47
What are the clinical manifestations of RTA type 2?
NAGMA with or without proximal tubular dysfunction **Hypokalemia** (mild compared to type 1)
48
how is RTA type 2 diagnosed?
Urine pH can be high or low, **but will be \<5.5 in steady state** UAG will be **negative**
49
unlike proximal RTA, distal RTA (type 1) patients are ____ to acidify their urine?
Type 1 RTA patients are _unable_ to acidify their urine
50
What is the etiology for type 1 RTA?
Sjögren's Syndrome Glue Sniffing
51
What are two clinical manifesations associated with RTA type 1?
Nephrolithiasis Neprhocalcinosis
52
What are the four diagnostic characteristics of RTA type 1?
NAGMA Unable to acidify urine to \<5.5 Hypokalemia UAG is positive
53
What are two main causes of RTA type 4? Both lead to what?
deficiency of circulating adolsterone (DM, drugs) Aldosterone resistance in CD (instl disease, drugs) Lead to impaired Na reabsorption leading to Hyperkalemia
54
What are the clinical manifestations of RTA type 4?
NAGMA Hyperkalemia often older pts with hx of DM or CKD
55
Diagnosis of RTA type 4 includes what?
variable urine pH, usually \>5.5 UAG is positive
56
Acidosis is associated with (hypo or hyperkalemia?) Alkalosis is associated with (hypo or hyperkalemia?)
hyperkalemia hypokalemia
57
Factors that stimulate Na reabsorption secondarily increase H secretion thus stimulating ___ reabsorption leading to a potential \_\_\_\_
HCO3; metabolic alkalosis
58
What are five main causes of metabolic alkalosis?
Hypokalemia Vomiting/NG tube Diuretics Volume depletion (contraction alkalosis) Mineralcorticoid excess
59
What are the clinical manifesttions of Bartter syndrome? What does this lead to? What type of diuretic does this mimic?
hypokalemia metabolic alkalosis low-norm BP hypercalciuria, nephrocalcinosis leads to NaCl loss, volume depletion and 2' hyperaldosteronism **mimics loop diuretics**
60
What are the clinical manifestations of Gitelman Syndrome? What diuretic does this mimic?
hypokalemia metabolic alkalosis low to norm BP **hypo**calciruia hypomagnesemia (TRPM6 channel downregulation) mimics thiazide diuretic
61
What is the clinical manifestation of Liddle Syndrome?
Autosomal dominant resistant to hypertension hypokalemia metabolic alkalosis
62
How is the diagnosis of Liddle syndrome made? how is it treated?
Genetic testing low aldosterone and renin levels treat with amiloride or triamterene and low Na diet
63
Anything that increases respiratory rate or TV causes what aberration?
Respiratory alkalosis | (esp. Pregnancy)
64
anything that lowers respiratory rate/TV, increases dead space, or worsens airway obstruction causes what aberration?
Respiratory acidosis
65
Inadequate ventilator settings and increased CO2 production can cause what aberration?
Respiratory Acidosis

CPR II Exam 3 (17 decks)

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