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CPR Exam 3 > Acid/Base Disorders > Flashcards

Acid/Base Disorders Flashcards

1
Q

What is the normal arterial blood pH

A

7.35-7.45

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2
Q

What is the most important buffering system?

A

The bicarbonate buffering system

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3
Q

Which organs play the largest roll in the bicarbonate buffering system?

A

Lungs (blow off CO2)

Kidneys (secrete acidic or alkaline urine)

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4
Q

What are the types of metabolic acidosis

A

High anion gap metabolic acidosis

Normal Anion gap metabolic acidosis

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5
Q

What are the types of metabolic alkalosis

A

Saline Responsive (hypovolemia aka contraction alkalosis)

Saline-non-responsive (euvolemic or hypervolemic)

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6
Q

In expected HC03 compensation for Respiratory Acidosis and Alkalosis, for every 10 mmHg increase in pCO2, what should the bicarb increase be for acute and chronic acidosis

A

Acute 1

Chronic 3.5

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7
Q

In expected HC03 compensation for Respiratory Acidosis and Alkalosis, for every 10 mmHg decrease in pCO2, what should the bicarb decrease be for acute and chronic alkalosis

A

Acute 2

Chronic 5

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8
Q

How many acid-base disturbances can be present at once

A

1-3

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9
Q

Outline the Acid-Base stepwise approach

A
  1. Determine if acidosis or alkalosis is present
  2. Determine if primary disturbance is metabolic or respiratory
  3. If metabolic calculate anion gap
    - -if hypoalbuminemia, corrected anion gap
    - - if HAGMA present calculate osmolar gap
    - - if HAGMA present consider delta-delta gap
  4. Calculate appropriate compensation for primary acid-base disorder
    - - if compensation is good, simple acid-base disorder present
    - - if compensation is bad, complex acid-base disorder
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10
Q

What is the normal HCO3 ABG value

A

24 mEq/L

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11
Q

What is the normal PCO2

A

40 mmHg

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12
Q

What is the normal Anion gap

A

12

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13
Q

What is the normal osmolality gap

A

10 mosm/kg

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14
Q

how do you calculate anion gap?

A

Na - (HCO3 + CL-)

normal value is 12 +/- 2

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15
Q

How do you calculate serum osmolality?

A

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

normal is 275-290

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16
Q

How do you calculate osmolar gap

A

Normal serum osmolality - Calculated

normal <10 -> screen for alcohol ingestion (HAGMA), ketoacidosis, lactic acidosis

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17
Q

When is the Delta-Delta gap useful

A

in patients with HAGMA to determine if there is a coexisting NAGMA

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18
Q

How do you calculate the Delta gap

A

Calculated AG - Normal AG

If measured HCO3 is = to [Normal HCO3 - (delta gap)] then no additional acid-base disturbance present

if measured HCO3 is greater than [] then there is Metabolic alkalosis + HAGMA

if measured HCO3 is less than [] then there is NAGMA in addition to HAGMA

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19
Q

What is the mnemonic for HAGMA

A

GOLD MARK

Glycols
Oxyproline (acetaminophen tox)
Lactic Acidosis
D- Lactic acidosis

Methanol
Aspirin
Renal Failure
Ketoacidosis

20
Q

What is the treatment of pyroglutamic (5-oxoproline) acidosis

A

Discontinue acetaminophen
IVF
N-acetylcysteine

Seen in women who are malnourished or critically ill

21
Q

What is the mnemonic for increased serum osmolality gap

A

MEDIE

Methanol
Ethanol
Diethylene Glycol
Isopropyl alcohol 
Ethylene Glycol
22
Q

What is the mnemonic for NAGMA

A

DURHAAM

Diarrhea*
Ureteral diversion 
RTA*
Hyperalimentation
Acetazolamide
Addison's Disease
Miscellaneous (toluene)
23
Q

What is the etiology of RTA

A

net acid excretion is impaired

Cannot be diagnosed in AKI

24
Q

What is type 1 RTA

A

decreased H+ ion secretion in distal tubules and collecting ducts

25
What is type 2 RTA
decreased HCO3 reabsorption in proximal tubule
26
What is RTA type 4
Decreased aldosterone secretion or aldosterone resistance -- leads to decreased net H+ and K+ secretion in collecting duct ****MOST COMMON
27
If you suspect RTA and have hyperkalemia, which RTA do you have?
Type 4 with positive urine anion gap
28
If you suspect RTA and have hypokalemia with proximal tubular dysfunction, which RTA do you have?
Type 2 with or without urine anion gap if you don't have proximal tubular dysfunction you have type 1 with urine anion gap
29
What is the function of measuring Urine Anion Gap
Differentiate Renal from non-renal NAGMA
30
What is the equation for UAG
(UrineNa + UrineK) - Urine Cl if negative - appropriate distal nephron acidification if positive - inappropriate distal nephron acidification
31
Describe RTA type 2
Proximal renal tubular acidosis decreased capacity to resorb bicarb leading to low serum bicarb -> to eventual stabilization at lower bicarb level
32
What are the clinical manifestations of Proximal RTA (type 2)
NAGMA with or without proximal tubular dysfunction Hypokalemia (mild compared to RTA 1)
33
What is the problem present in RTA type 1
unable to acidify urine can be caused by amphotericin
34
What is the main clinical manifestation of distal RTA (type 1)
Nephrolithiasis or nephrocalcinosis NAGMA Urine pH >5.5 Hypokalemia UAG positive
35
What are the two main etiologies of Hyperkalemic RTA (type 4)
Deficiency in circulating aldosterone) Aldosterone resistance in collecting ducts
36
What are the clinical manifestations of Hyperkalemic RTA (type 4)
``` Usually asymptomatic NAGMA Hyperkalemia Most pts in 50-70s with hx of DM or CKD UAG positive ```
37
Acidosis:Hyperkalemia::Alkalosis:
Hypokalemia
38
What factors stimulate Na resorption, secondarily increase H+ secretion and thus stimulate HCO3 reabsorption leading to metabolic alkalosis
``` Hypokalemia N/V Diuretics Volume depletion Mineralocorticoid excess ```
39
Whom does Bartter syndrome affect
Prenatal or neonatal pts rare AR disease
40
what are the clinical manifestations of Bartter syndrome
severe hypokalemia metabolic alkalosis Low to normal BP Hypercalciuria and nephrocalcinosis
41
Bartter syndrome types and their affected channels mnemonic
In order (1-4) No - NKCC2 Regular - ROMK Cock - CLC-Kb Block - Barttin Mutation (3/4 same channel)
42
Whom does gitelman syndrome affect
Late childhood or adulthood AR more common than Bartter
43
What are the clinical manifestations of Gitelman syndrome
Severe hypokalemia Metabolic Alkalosis (saline non-responsive) Low to normal BP Hypocalciuria (opposite bartter syndrome) Hypomagnesemia
44
Whom is affected by liddle syndrome
young patients with HTN and electrolyte abnormalities rare AD disease
45
What are the clinical manifestations of Liddle syndrome
Resistant HTN Hypokalemia Metabolic Alkalosis (saline non-responsive)
46
Describe the pathophysiology of liddle syndrome and the treatment
Mutation in the ENaC channel increasing their number Treat with Amiloride or triamterene, low salt diet don't use spironolactone

CPR Exam 3 (15 decks)

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