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Residency Exam > Acid Base Disturbances (Panopto Video link) > Flashcards

Acid Base Disturbances (Panopto Video link) Flashcards

1
Q

At what pH do our enzymes/biological reactions function best at?

A

7.35 to 7.45

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2
Q

What is a common cause of acid-base disorders?

A

Life-threatening diseases

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3
Q

What may the presence of an acid-base disorder help to indicate?

A

The severity of the illness

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4
Q

What are the 2 main systems for maintenance of pH?

A
  1. Buffer system (bicarbonate most important)
  2. Excretory systems (kidney and lungs)
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5
Q

What is the most important buffer in maintaining physiological pH?

A

Bicarbonate

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6
Q

What are 4 sources of pH buffers in the extracellular fluid?

A
  1. Bicarbonate
  2. Haemoglobin (Hb)
  3. Phosphate
  4. Plasma proteins
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7
Q

What is a disorder with a primary decrease in plasma bicarbonate concentration called?

A

Metabolic acidosis

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8
Q

What is a disorder with a primary increase in plasma bicarbonate concentration called?

A

Metabolic alkalosis

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9
Q

What is a disorder with a primary increase in arterial blood carbon dioxide called?

A

Respiratory acidosis

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10
Q

What is a disorder with a primary decrease in arterial carbon dioxide calls?

A

Respiratory alkalosis

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11
Q

What is the only way a respiratory alkalosis can occur?

A

Hyperventilation (including in patients on ventilators)

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12
Q

What are metabolic acid-base disorders defined as?

A

Primary disorders of plasma bicarbonate concentration

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13
Q

What are respiratory acid-base disorders defined as?

A

Primary disorders of blood carbon dioxide

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14
Q

What is a natural byproduct of the reaction between bicarbonate and hydrogen (acid)?

A

Carbon dioxide

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15
Q

What is the ratio of bicarbonate to carbon dioxide required to maintain a physiological pH of 7.4?

A

20:1

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16
Q

If bicarbonate concentrations increase, the body will increase the concentration of what buffer to maintain physiological pH?

A

Carbon dioxide

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17
Q

What is the body’s natural response if bicarbonate concentrations decrease?

A

Carbon dioxide will also decrease to maintain physiological pH

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18
Q

What is the body’s natural response if carbon dioxide concentrations increase?

A

Bicarbonate will also increase to maintain physiological pH

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19
Q

What is the body’s natural response if carbon dioxide concentrations decrease?

A

Bicarbonate will also decrease to maintain physiological pH

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20
Q

Is bicarbonate acidic or basic?

A

Basic

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21
Q

Is carbon dioxide acidic or basic?

A

Acidic

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22
Q

What are physiological bicarbonate levels mainly regulated by?

A

The kidneys

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23
Q

What are physiological carbon dioxide levels mainly regulated by?

A

The lungs

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24
Q

What are the 3 physiological systems which regulate hydrogen (acid) levels in the body?

A
  1. Buffering of body fluids
  2. Respiration (removal of carbon dioxide)
  3. Kidneys (excretion of hydrogen ions or retention of hydrogen ions)
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25
Q

What is the pathophysiology by which metabolic acidosis occurs?

A

When normal metabolism is impaired, acid forms

26
Q

What is an example of acid forming when normal metabolism is impaired?

A

Poor blood supply stops oxidative metabolism, and lactic acid forms

27
Q

What are 4 examples of causes of metabolic acidosis?

A
  1. Increased produce of non-volatile acids (such as ketoacid, lactic acid)
  2. Failure of the kidney to excrete non-volatile acids
  3. Failure of the kidney to conserve base
  4. Excess loss of buffer base (such as in gastroenteritis)
28
Q

What are 2 examples of non-volatile acids which can accumulate in metabolic acidosis?

A
  1. Ketoacid
  2. Lactic acid
29
Q

What is an example of a condition which can cause metabolic acidosis via excess loss of buffer base?

A

Gastroenteritis

30
Q

What is an example of a condition which can cause metabolic acidosis via excess loss of buffer base?

A

Gastroenteritis

31
Q

What is an example of a condition which may cause metabolic acidosis by inability of the kidney to conserve base?

A

Renal tubular acidosis

32
Q

What are 2 causes of metabolic alkalosis?

A
  1. Excess loss of non-volatile acid(s)
  2. Excess intake of bicarbonate
33
Q

If the source of vomiting is from the upper gastrointestinal tract, is this likely to cause acid or base loss?

A

Acid loss

34
Q

If the source of vomiting is from the lower gastrointestinal tract, is this likely to cause acid or base loss?

A

Base loss

35
Q

What is an organ involved in base buffer production in the gastrointestinal tract?

A

The pancreas

36
Q

What is the pathophysiology by which respiratory acidosis occurs?

A

When breathing is inadequate, carbon dioxide (respiratory acid) accumulates. The high carbon dioxide concentration forms carbonic acid which contributes to an acidic pH

37
Q

What does the anion gap measure?

A

It measures the concentrations of anions and cations in the body which cannot be measured

38
Q

How is the anion gap calculated?

A

Sodium concentration – chloride concentration – bicarbonate concentration

39
Q

What is a normal anion gap metabolic acidosis also called?

A

Hyperchloraemic metabolic acidosis

40
Q

What is a high anion gap metabolic acidosis also called?

A

Normochloraemic metabolic acidosis

41
Q

What are 8 common causes of high anion gap metabolic acidosis?

A

GOLDMARK:
1. Glycols (ethylene glycol and propylene glycol)
2. Oxoproline (with paracetamol overdose)
3. L-Lactate
4. D-Lactate
5. Methanol
6. Aspirin
7. Renal failure
8. Ketoacidosis

42
Q

What are 8 common causes of high anion gap metabolic acidosis?

A

GOLDMARK:
1. Glycols (ethylene glycol and propylene glycol)
2. Oxoproline (with paracetamol overdose)
3. L-Lactate
4. D-Lactate
5. Methanol
6. Aspirin
7. Renal failure
8. Ketoacidosis

43
Q

What are 8 common causes of high anion gap metabolic acidosis?

A

GOLDMARK:
1. Glycols (ethylene glycol and propylene glycol)
2. Oxoproline (with paracetamol overdose)
3. L-Lactate
4. D-Lactate
5. Methanol
6. Aspirin
7. Renal failure
8. Ketoacidosis

44
Q

What are 8 common causes of high anion gap metabolic acidosis?

A

GOLDMARK:
1. Glycols (ethylene glycol and propylene glycol)
2. Oxoproline (with paracetamol overdose)
3. L-Lactate
4. D-Lactate
5. Methanol
6. Aspirin
7. Renal failure
8. Ketoacidosis

45
Q

What are 8 common causes of high anion gap metabolic acidosis?

A

GOLDMARK:
1. Glycols (ethylene glycol and propylene glycol)
2. Oxoproline (with paracetamol overdose)
3. L-Lactate
4. D-Lactate
5. Methanol
6. Aspirin
7. Renal failure
8. Ketoacidosis

46
Q

What is a condition associated with an accumulation of D-Lactate, subsequently leading to a high anion gap metabolic acidosis?

A

Short bowel syndrome

47
Q

What is a condition associated with an accumulation of L-Lactate, subsequently leading to a high anion gap metabolic acidosis?

A

Impaired anaerobic glycolysis (inability to clear the lactate produced by the body)

48
Q

What are the 2 mechanisms of high anion gap acidosis?

A
  1. Decreased excretion of acids
  2. Increased production of acids
49
Q

What are 3 mechanisms of normal anion gap acidosis?

A
  • ingestions
  • Increased bicarbonate losses
  • Decreased hydrogen excretion
50
Q

What is a cause of decreased excretion of acids leading to high anion gap acidosis?

A

Renal failure

51
Q

What are 3 causes of increased production of acids, leading to high anion gap acidosis?

A
  1. Lactic acidosis: tissue hypoperfusion
  2. Ketoacidosis (diabetic, alcoholic, starvation)
  3. Ingestions (salicylate, methanol, ethylene glycol)
52
Q

What are 3 causes of increased losses of bicarbonate, leading to normal anion gap acidosis?

A
  1. Extrarenal causes: diarrhoea, small bowel drainage
  2. Renal causes: proximal renal tubular acidosis, acetazolamide
  3. Recovery from diabetic ketoacidosis
53
Q

What are 2 causes of decreased hydrogen ion secretion, leading to normal anion gap acidosis?

A
  1. Distal (Type 1 and Type 4) renal tubular acidosis
  2. Renal failure
54
Q

What are 3 ingestions which can lead to normal anion gap acidosis?

A
  1. NH4Cl
  2. Lysine
  3. Arginine HCl
55
Q

What is generally the best laboratory value to look at (after pH) when assessing an acid-base disorder?

A

Bicarbonate

56
Q

What is the reference range for bicarbonate?

A

22-28 mEq/L

57
Q

What is the reference range for paCO2?

A

35 to 45 mm Hg

58
Q

What is the gold standard sample for a pH test?

A

An arterial blood gas

59
Q

What are two benefits of a venous blood gas over an arterial blood gas?

A

They are less painful and easier to do

60
Q

How does venous blood gas analysis compare to arterial blood gas analysis?

A

Venous blood gas analysis compares well with arterial blood gas for pH, pCO2 and HCO3- estimations, but not for pO2 in patients with an acute exacerbation of chronic obstructive pulmonary disease

61
Q

What is the reference range for blood pH?

A

7.35-7.45

Residency Exam (22 decks)

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