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CPR Exam 2 > Acid Base Disturbances > Flashcards

Acid Base Disturbances Flashcards

1
Q

What is the primary defect and effect on pH during respiratory acidosis?

A 
Alveolar hypoventilation (increased paCO2) 
Decreased pH
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2
Q

What is the compensatory response for respiratory acidosis?

A

Increase renal HCO3 reabsorption to increase plasma [HCO3]

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3
Q

What is the primary defect and effect on pH of respiratory alkalosis?

A 
Alveolar hyperventilation (decreased PaCO2) 
Increased pH
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4
Q

What is the compensatory response for respiratory alkalosis?

A

Decreased renal HCO3 reabsorption (to decrease [HCO3]

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5
Q

What is the primary defect in metabolic acidosis?

A

Loss of HCO3 or gain of H

Decreased pH

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6
Q

What is the compensatory response for metabolic acidosis?

A

Alveolar hyperventilation to increase pulmonary CO2 excretion (decrease PaCO2)

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7
Q

What is the primary defect during metabolic alkalosis?

A

Gain of HCO3 or loss of H

Increased ph

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8
Q

What is the compensatory response during metabolic alkalosis?

A

Alveolar hypoventilation to decrease pulmonary CO2 excretion (increase PaCO2)

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9
Q

What are the causes for acute respiratory acidosis?

A

CNS depression, airway obstruction, neuromuscular disorders, severe pneumonia embolism and edema
CANS

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10
Q

What are the causes of chronic respiratory acidosis?

A

COPD

Anything chronic that leads to impaired ventilation

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11
Q

For every 10mmHg increase in PaCO2 during acute chronic respiratory acidosis the HCO3 should increase by how much?

A

1 mEq/L

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12
Q

For every 10mmHg increase in PaCO2 during chronic respiratory acidosis the HCO3 should increase by how much?

A

3.5 mEq/L

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13
Q

For every 10mmHg decrease in PaCO2 during acute respiratory alkalosis, the HCO3 should decrease by how much?

A

2 mEq/L

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14
Q

For every 10mmHg decrease in PaCO2 in chronic respiratory alkalosis, there should be a decrease in HCO3 by how much?

A

5 mEq/L

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15
Q

What are the causes for respiratory alkalosis?

A 
CNS disease —> hyperventilation 
Hypoxia 
Anxiety 
Mechanical ventilators 
Progesterone (stimulates respiratory center during pregnancy) 
Salicylates (aspirin)/sepsis 
CHMAPS
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16
Q

What are some causes for high anion gap metabolic acidosis (HAGMA)?

A 
Glycols (ethylene or propylene) 
Oxoproline (pyroglutamic acid) - intermediate of acetaminophen toxicity 
L-lactate 
D-lactate (unusual, e.g. when short bowel resection —> overproduction by lactobacilli after a carbohydrate load) 
Methanol 
Aspirin 
Renal failure 
Ketoacidosis 
GOLDMARK
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17
Q

What are some causes for non anion gap metabolic acidosis (NAGMA)?

A

Hyperalimentation (high Cl in TPN)
Acetazolamide
Renal tubular acidosis (1, 2 and 4) (main cause)
Diarrhea (main cause)
Ureterosigmoid fistula (colon wastes HCO3)
Posthypocapnia or pancreatic fistula (wastes HCO3)
Spironolactone
HARDUPS

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18
Q

What are other causes for high anion gap metabolic acidosis (MUDPILERS)?

A 
Methanol 
Uremia 
DKA/alcoholic KA 
Paraldehyde (obsolete sedative hypnotic) 
Isoniazid (used to tx tuberculosis) 
Lactic acidosis 
EtOH/ethylene glycol 
Rhabdo/renal failure 
Salicylates
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19
Q

What is Winter’s formula?

A

PaCO2 = (1.5 x [HCO3]) + 8 +/- 2

Used during metabolic acidosis

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20
Q

If there is hypokalemia and urine Cl is >20 mEq/L, what is indicated?

A

Chloride resistant metabolic alkalosis caused by hyperaldosteronism, K+ losing diuretics, etc

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21
Q

What does it mean when anion gap is high?

A

Means other solutes in plasma (alcohols, lactic acidosis, ketoacidosis)

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22
Q

How is anion gap calculated?

A

[Na+] - [Cl-] + [HCO3-]

Normal range between 8-16

23
Q

What is the delta gap?

A

Calculated anion gap - normal anion gap

24
Q

What is the delta [HCO3]?

A

Normal HCO3 - delta gap

25
Q

If measured [HCO3] is equal to the delta HCO3 then what disorder is present?

A

Simple acid base disorder

26
Q

If measured [HCO3] is greater than delta [HCO3] then what disorder is present?

A

Metabolic alkalosis + HAGMA

27
Q

If measured [HCO3] is less than delta [HCO3] then what disorder is present?H

A

Non gap metabolic acidosis + HAGMA

28
Q

If the delta AG/delta HCO3 ratio is 1:1, what is occurring?

A

Simple HAGMA

29
Q

If the delta delta ratio is <1 what is occurring?

A

Also losing HCO3 somewhere else (e.g. via diarrhea) or kidneys are rapidly eliminating anion (e.g. ketoacids, D-lactate)

30
Q

If the delta delta ratio is >1 up to 2 what does this suggest?

A

Lactic acidosis
L-lactate is reabsorbed by the kidney, kidney function often compromised —> maintenance of lactate levels
Intracellular buffering of H+ means serum HCO3 doesnt fall as much

31
Q

If delta delta ratio is close to or >2 what does this suggest?

A

Concurrent metabolic alkalosis or baseline HCO is elevated due to chronic respiratory acidosis

32
Q

What is renal tubular acidosis?

A

Acidemia + normal anion gap + normal serum creatinine and no diarrhea

33
Q

What is the primary defect occurring in type 1 RTA?

A

Impaired H secretion due to impaired function of alpha intercalated cells
“Classic distal”
Rare

34
Q

What is the primary defect occurring in type 2 “proximal” RTA?

A

Impaired proximal HCO3 reabsorption

Very rare

35
Q

What is the primary defect occurring in type 4 “Hyperkalemic” RTA?

A

Lack of aldosterone or failure of kidney to respond to it
High K and low NH3 synthesis by PT
Most common form

36
Q

What is a secondary cause for type I RTA?

A

Autoimmune disorders

37
Q

What are secondary causes for type 2 RTA?

A

Fanconi’s syndrome

In adults, multiple myeloma, various drugs

38
Q

What are potassium levels during type 1 and 2 RTA?

A

Hypokalemia

39
Q

What are the potassium levels during type 4 RTA?

A

Hyperkalemia

40
Q

What are the causes of metabolic acidosis?

A 
Contraction (e.g. selective loss of NaCl in urine, keeping HCO3)
Licorice (if real, sweet glycyrrhizic acid blocks normal conversion of Aldo-agonist cortisol to cortisone in kidney so that it drive Na/K exchange) 
Endo (Conn, Cushing, Bartter) 
Vomiting (lose HCl) 
Excess alkali 
Refeeding alkalosis 
Post hypercapnia 
Diuretics (volume contraction + K loss)
41
Q

What are the causes for chloride responsive metabolic alkalosis?

A

Vomiting, diuretics, nasogastric suction, diarrhea, villous adenoma

42
Q

Describe Cl responsive metabolic alkalosis

A

Spot urine Cl should be less than 10 mEq/L (unless recent diuretic use) since the kidney should be conserving Cl
Tx with normal saline should fix the disturbance

43
Q

What are the causes of Cl resistance metabolic alkalosis?

A

Distal exchange site stimulation by aldosterone resulting in increase H and K excretion in exchange for reabsorption of Na as NaHCO3, ongoing diuretic use/abuse

44
Q

Describe Cl resistant metabolic alkalosis

A

Spot urine Cl >20 mEq/L despite fact kidney should be conserving Cl
Need to treat cause of H loss in order to treat the alkalosis

45
Q

What are the sx for acute (or acutely worsening chronic) respiratory acidosis?

A

HA, confusion, anxiety, drowsiness, stupor tremors, convulsions, possible coma (CO2 narcosis)

46
Q

What are the sx for slowly developing but stable (as in COPD) respiratory acidosis?

A

May be well tolerated
Pts have have memory loss, sleep disturbances, excessive daytime sleepiness and personality changes
Signs include gait disturbance, tremor, blunted DTRs, myoclonic jerks (brief involuntary twitching of muscle/muscle group), asterixis (flapping wrist) and papilledema

47
Q

What are the sx of acute respiratory alkalosis?

A

Light headedness, confusion, peripheral and circumoral (around the lips) paresthesia, cramps and syncope
Thought to be due changes in cerebal blood flow and pH
Tachypnea or hyperpnea is often only sign

48
Q

What can be seen with severe acute respiratory alkalosis?

A

Capopedal spasm due to decreased levels of hypocalcemia (Ca driven inside cells in exchange for H)

49
Q

What are the sx for chronic respiratory alkalosis?

A

Usually asymptomatic

No distinctive signs

50
Q

What are the sx for mild metabolic acidosis?

A

Usually asymptomatic

51
Q

What are the sx for metabolic acidosis with a pH <7.10 (or higher change if developed rapidly)?

A

Nausea, vomiting, malaise

See long deep breaths at normal rate (respiratory compensation) without dyspnea

52
Q

What are the signs and sx of mild metabolic alkalosis?

A

Signs and sx of underlying disorder

53
Q

What are the sx for more severe metabolic alkalosis?

A

Increased binding of Ca leading to Hypocalcemia
HA, lethargy and neuromuscular excitability, sometimes with delirium, tetany and seizures
Lowered threshold for angina sx and arrhythmias
Possible weakness if also hypokalemia

CPR Exam 2 (18 decks)

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