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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
Q

What is the normal PCO2?

A

40

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26
Q

What is the normal anion gap?

A

12

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27
Q

What is the normal osmolality gap?

A

10

28
Q

What is the formula for anion gap?

What is anion gap used to determine?

A

Na-(HCO+Cl)

Normal AG is 12+/-2

HAGMA vs. NAGMA

29
Q

If HAGMA is present, calculate the osmolality using the following formula:

Find the olsmolar gap how?

A

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

normal: 275-290

gap= measured serum osmolality-calculated serum osmolality

normal: <10

30
Q

If anion gap is >20, what is this highly suspicious for?

A

Alcohol ingestion

(likely seen with HAGMA)

31
Q

What is delta-delta gap used for?

A

Used in patients with HAGMA to determine if there is a coexisiting NAGMA or metabolic alkalosis present

32
Q

What are the GOLDMARK causes of HAGMA?

A

Glycols

Oxyproline

L-Lactic acidosis

D-Lactic acidosis

Methanol

Aspirin

Renal failure

Ketoacidosis

33
Q

Which cause of acidosis is commonly seen in women who are malnourished or critically ill?

Diagnosed how?

Treated how?

A

Pyroglutamic (5-oxoproline) acidosis

Diagnosed via urinary organic acid screen

Stop Tylenol; Give IVF and NAC

34
Q

What are the causes of increased osmolar gap?

A

Methanol

Ethanol

Dietheylene Glycol

Isopropyl Alcohol

Ethylene glycol

Propylene glycol

Ketoacidosis/lactic acidosis

35
Q

Methanol metabolizes to formic acid which can cause which aberration?

Ethylene glycol metabolizes to oxalic acid which can cause which aberration?

A

blindness

Renal failure

36
Q

What are the DURHAAM causes of NAGMA?

A

Diarrhea

ureteral diversion or fistula

renal tubular acidosis

hyperalimentation

acetazolamide

addison’s disease

Misc.

37
Q

When net acid excretion by the kidneys is impaired resulting in a NAGMA without any s/s of AKI, what is the likely diagnosis?

A

Renal Tubular Acidosis

38
Q

What is RTA 1?

A

results from decreased net H ion secretion in distal tubules and CD

39
Q

What is RTA 2?

A

results from decreased HCO3 reabsorption in the proximal tubules

40
Q

What is RTA 4?

A

results from decreased aldosterone secretion or aldosterone resistance

41
Q

IF RTA is suspected and hypokalemia is present with proximal tubular dysfunction (AA, glucose, bicarb in urine) what is the diagnosis?

A

Type 2 RTA

urine anion gap will be negative

42
Q

If RTA is suspected and hypokalemia is present without proximal tubular dysfunction, what is the diagnosis?

A

Type 1 RTA

urine anion gap will be positive

43
Q

If RTA is suspected and hyperkalemia is present, what is the diagnosis?

A

Type 4 RTA

urine anion gap will be +

most common type, often seen with DM2 or CKD

44
Q

What is the urine anion gap used for?

How is it calculated?

A

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
Q

Along the nephron, as H ions are secreted, what is reabsorbed at a 1:1 ratio?

A

HCO3

46
Q

What is the etiology for RTA 2?

A

common cause in children is cystinosis

common cause in adults is Fanconi Syndrome caused by Multiple Myeloma

47
Q

What are the clinical manifestations of RTA type 2?

A

NAGMA with or without proximal tubular dysfunction

Hypokalemia (mild compared to type 1)

48
Q

how is RTA type 2 diagnosed?

A

Urine pH can be high or low, but will be <5.5 in steady state

UAG will be negative

49
Q

unlike proximal RTA, distal RTA (type 1) patients are ____ to acidify their urine?

A

Type 1 RTA patients are unable to acidify their urine

50
Q

What is the etiology for type 1 RTA?

A

Sjögren’s Syndrome

Glue Sniffing

51
Q

What are two clinical manifesations associated with RTA type 1?

A

Nephrolithiasis

Neprhocalcinosis

52
Q

What are the four diagnostic characteristics of RTA type 1?

A

NAGMA

Unable to acidify urine to <5.5

Hypokalemia

UAG is positive

53
Q

What are two main causes of RTA type 4?

Both lead to what?

A

deficiency of circulating adolsterone (DM, drugs)

Aldosterone resistance in CD (instl disease, drugs)

Lead to impaired Na reabsorption leading to Hyperkalemia

54
Q

What are the clinical manifestations of RTA type 4?

A

NAGMA

Hyperkalemia

often older pts with hx of DM or CKD

55
Q

Diagnosis of RTA type 4 includes what?

A

variable urine pH, usually >5.5

UAG is positive

56
Q

Acidosis is associated with (hypo or hyperkalemia?)

Alkalosis is associated with (hypo or hyperkalemia?)

A

hyperkalemia

hypokalemia

57
Q

Factors that stimulate Na reabsorption secondarily increase H secretion thus stimulating ___ reabsorption leading to a potential ____

A

HCO3; metabolic alkalosis

58
Q

What are five main causes of metabolic alkalosis?

A

Hypokalemia

Vomiting/NG tube

Diuretics

Volume depletion (contraction alkalosis)

Mineralcorticoid excess

59
Q

What are the clinical manifesttions of Bartter syndrome?

What does this lead to?

What type of diuretic does this mimic?

A

hypokalemia

metabolic alkalosis

low-norm BP

hypercalciuria, nephrocalcinosis

leads to NaCl loss, volume depletion and 2’ hyperaldosteronism

mimics loop diuretics

60
Q

What are the clinical manifestations of Gitelman Syndrome?

What diuretic does this mimic?

A

hypokalemia

metabolic alkalosis

low to norm BP

hypocalciruia

hypomagnesemia (TRPM6 channel downregulation)

mimics thiazide diuretic

61
Q

What is the clinical manifestation of Liddle Syndrome?

A

Autosomal dominant

resistant to hypertension

hypokalemia

metabolic alkalosis

62
Q

How is the diagnosis of Liddle syndrome made?

how is it treated?

A

Genetic testing

low aldosterone and renin levels

treat with amiloride or triamterene and low Na diet

63
Q

Anything that increases respiratory rate or TV causes what aberration?

A

Respiratory alkalosis

(esp. Pregnancy)

64
Q

anything that lowers respiratory rate/TV, increases dead space, or worsens airway obstruction causes what aberration?

A

Respiratory acidosis

65
Q

Inadequate ventilator settings and increased CO2 production can cause what aberration?

A

Respiratory Acidosis

CPR II Exam 3 (17 decks)

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