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Electrolytes and Acid-Base disturbances > Acid-Base Disturbances > Flashcards

Acid-Base Disturbances Flashcards

1
Q 
Respiratory Acidosis 
(pH, Bicarbonate change, Compensation)
A
  • pH < 7.35
  • Increased HCO3-
  • Compensation:
  • Acute (uncompensated): every 1 mmHg rise in PaCO2 there is a 0.1 mEq/L rise in HCO3- (1:0.1 ratio)
  • Chronic (compensated): every 1 mmHg rise in PaCO2 there is a 0.35 mEq/L rise in HCO3- (1:0.35 ratio)
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2
Q 
Respiratory Alkalosis
(pH, Bicarbonate change, Compensation)
A
  • pH > 7.45
  • Decreased HCO3-
  • Compensation:
  • Acute (uncompensated): every 1 mmHg fall in PaCO2 there is a 0.2 mEq/L fall in HCO3- (1:0.2 ratio)
  • Chronic (compensated): every 1 mmHg fall in PaCO2 there is a 0.5 mEq/L fall in HCO3- (1:0.5 ratio)
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3
Q 
Metabolic Acidosis
(pH, Bicarbonate change, Compensation)
A
  • pH < 7.35
  • Decreased HCO3-
  • Compensation:
  • Winter’s equation to calculate predicted PaCO2
  • PaCO2 = (1.5 * HCO3-) + 8
  • If the measured PaCO2 is +/- 2 of the calculated value then there is respiratory compensation
  • If it is higher than 2 then there is inadequate respiratory response and the patient has metabolic and respiratory acidosis
  • If the measured PaCO2 is too low, then the patient has metabolic acidosis with a respiratory alkalosis
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4
Q 
Metabolic Alkalosis
(pH, Bicarbonate change, Compensation)
A
  • pH > 7.45
  • Increased HCO3-
  • Compensation:
  • Expected PaCO2 = (0.7 * rise in HCO3-) + 40
  • If the measured PaCO2 is +/- 2 of the calculated value then there is respiratory compensation
  • If it is higher than 2 then there is inadequate respiratory response and the patient has metabolic alkalosis and respiratory acidosis
  • If the measured PaCO2 is too low, then the patient has metabolic and respiratory alkalosis
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5
Q

Plasma Anion Gap

Equation, Normal value, Use

A
  • Gap = [Na+] - ([Cl-] + [HCO3-])
  • Value is 12 +/- 2
  • In metabolic acidosis
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6
Q

Elevated Plasma Anion Gap

Causes

A

MUDPILES

  • Methanol
  • Uremia (renal failure)
  • DKA
  • Paraldehyde or Phenformin
  • Iron and Isoniazid
  • Lactic acidosis
  • Ethylene glycol (oxalic acid) and ethanol ketoacidosis
  • Salicylates (late), starvation ketoacidosis and sepsis
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7
Q

Normal Plasma Anion Gap

Causes

A

HARD ASS UP

  • Hyperchloremia or Hyperalimenation (parental nutrition)
  • Addison disease
  • Renal tubular acidosis
  • Diarrhea
  • Acetazolamide
  • Spironolactone
  • Saline infusion
  • Ureteral diversion
  • Pancreatic fistula
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8
Q 
Respiratory Acidosis 
(Causes)
A
  • Respiratory center depression (anesthetics, morphine)
  • Pulmonary edema, cardiac arrest
  • Airway obstruction
  • Muscle relaxants
  • Sleep apnea
  • COPD
  • Neuromuscular defects (multiple sclerosis, muscular dystrophy)
  • Obesity hypoventilation syndrome
  • Kyphoscoliosis
  • Drowning
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9
Q

Respiratory Alkalosis

Causes

A
  • Conversion disorder
  • Anxiety
  • Fever and pain
  • Anemia
  • Hypoxemia
  • Pneumothorax (in some cases)
  • Ventilation-perfusion inequality
  • Hypotension
  • High altitude
  • Pulmonary embolism
  • Salicylates (early)
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10
Q

Metabolic Alkalosis

Causes

A
  • Vomiting or gastric suctioning
  • Loop and thiazide diuretics
  • Bartter, Gitelman and Liddle syndromes
  • Intracellular shift of H+ as in hypokalemia
  • Increased aldosterone:
  • Primary hyperaldosteronism
  • Cushing syndrome
  • Ectopic ACTH
  • Volume contraction (loss of bicarbonate-free fluid)
  • Liquorice
  • Milk-alkali syndrome (due to high calcium from antacid use or calcium supplements for osteoporosis)
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11
Q

RTA Type I

Causes

A
  • Amphotericin B and Lithium toxicity
  • Analgesic nephropathy
  • Congenital anomalies (obstruction) of urinary tract
  • Cirrhosis
  • Autoimmune disorders like Sjogren’s syndrome and SLE
  • Hypercalciuria
  • Sickle cell anemia
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12
Q

RTA Type II

Causes

A
  • Fanconi syndrome
  • Carbonic anhydrase inhibitors
  • Multiple myeloma
  • Amyloidosis
  • Heavy metal poisoning
  • Vitamin D deficiency
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13
Q

RTA Type IV

Causes

A
  • Decreased aldosterone production:
  • Diabetic hyporeninism (most common)
  • ACEIs, ARBs, NSAIDs, heparin, cyclosporine
  • Adrenal insufficiency
  • Aldosterone resistance:
  • K+-sparing diuretic and TMP/SMX
  • Nephropathy due to obstruction
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14
Q

RTA Type I

Site and Mechanism of defect, Serum K+

A
  • DCT
  • Defect in the ability of alpha-intercalated cells to secrete H+ leading to impairment of generation of new bicarbonate
  • Hypokalemia
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15
Q

RTA Type II

Site and Mechanism of defect, Serum K+

A
  • PCT
  • Defect in bicarbonate reabsorption leading to increase bicarbonate excretion in urine
  • Hypokalemia
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16
Q

RTA Type IV

Site and Mechanism of defect, Serum K+

A
  • DCT and collecting ducts
  • Aldosterone decreased production or resistance which leads to decrease NH3 synthesis in PCT, thereby decreased NH4+ excretion
  • Hyperkalemia
17
Q

RTA Type I

Diagnosis

A
  • Urine pH > 5.5

- Urine pH will remain over 5.5 after we infuse acid into blood with ammonium chloride

18
Q

RTA Type II

Diagnosis

A
  • Urine pH first is > 5.5 then it will be < 5.5 (when most bicarbonate is lost from the body)
  • Urine pH will rise after giving bicarbonate to the patient (kidney cannot absorb bicarbonate)
19
Q

RTA Type IV

Diagnosis

A
  • Urine pH < 5.5

- Persistently high urine Na+ despite sodium-depleted diet; in addition to hyperkalemia

20
Q

RTA Type I

Complications

A

Nephrolithiasis (calcium oxalate)

21
Q

RTA Type II

Complications

A
  • Rickets

- Osteomalacia

22
Q

RTA Type IV

Complications

A

Hyperkalemia complications

23
Q

RTA Type I

Treatment

A

Replace bicarbonate

24
Q

RTA Type II

Treatment

A

Thiazides (volume depletion will lead to increase bicarbonate reabsorption)

25
Q

RTA Type IV

Treatment

A
  • Furosemide

- Mineralocorticoid +/- glucocorticoid replacement like Fludrocortisone

26
Q

Urine Anion Gap (UAG)

Equation, Use

A
  • UAG = Urine Na+ - Urine Cl-
  • It is used to distinguish between diarrhea and RTA as causes of normal plasma anion gap metabolic acidosis as the following:
  • UAG is +ve in RTA
  • UAG is -ve in diarrhea
27
Q

Minute Ventilation

Equation, Use

A
  • Minute Ventilation = Respiratory rate * Tidal volume
  • It is used to distinguish respiratory acidosis from respiratory alkalosis as the following:
  • Increased in respiratory alkalosis
  • Decreased in respiratory acidosis

Electrolytes and Acid-Base disturbances (3 decks)

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