Acid Base II

Question 1

What is the modified henderson hasselbach equation?

Answer 1

pH = 6.1 + log (HCO3/ .03 X PCO2)

Question 2

What is responsible for the majority of increased renal H secretion during metabolic acidosis?

Answer 2

enhanced NH4+ excretion

Question 3

What is the primary alteration in metabolic acid base disorders?

Answer 3

blood bicarb composition

Question 4

what is the primary alteration in respiratory acid base disorders?

Answer 4

blood PCO2

Question 5

What is another name for non anion gap metabolic acidosis?

Answer 5

hyperchloremic acidosis

Question 6

Why would a non AG metabolic acidosis not have an AG?

Answer 6

In a pure form of hyperchloremic acidosis, therefore, the increase in chloride above the normal value should be equal to the decrease in bicarbonate.

Question 7

What are 4 main classifications for normal AG acidosis?

Answer 7

bicarb wastage
impaired H secretion and reduced NH4+ excretion
impaired NH3 formation and reduced NH4 excretion
administration of chloride containing acid

Question 8

Diarrhea and urinary tract diversions are examples of what kind of normal AG acidosis?

Answer 8

bicarb wasting

Question 9

distal RTA and aldosterone deficiency are examples of what kind of non AG acidosis?

Answer 9

impaired renal H secretion and reduced NH4 excretion

Question 10

advanced CKD and hyperkalemia are examples of what kind of non AG acidosis?

Answer 10

impaired NH3 formation and reduced NH4 excretion

Question 11

In severe diarrhea, what is true of bicarb levels in the urine?

Answer 11

there is none - low urine pH and increased ammonium and titratable acid

Question 12

What does a large negative UAG suggest about an acidosis?

Answer 12

that NH4 is in the urine and the kidney is appropriately compensating

Question 13

Diabetes, alcohol and starvation would cause what kind of AG acidosis?

Answer 13

ketoacidosis

Question 14

shock, tissue hypoxia, and liver failure would cause what kind of AG acidosis?

Answer 14

renal failure/lactate

Question 15

increased osmolal gap and hyperemic optic disc would cause what kind of AG acidosis?

Answer 15

methanol/formate

Question 16

Increased osmolal gap;urinary oxalate crystals; acute kidney failure would all suggest what kind of AG acidosis?

Answer 16

ethylene glycol

Question 17

An AG acidosis with concomitant respiratory alkalosis would suggest what cause?

Answer 17

salicylates

Question 18

When alkalosis occurs in the setting of decreased ECF, what happens to bicarb excretion? i.e. in vomiting (which causes fluid and H loss)

Answer 18

it is limited, so correcting the alkalosis requires fixing the volume issue before renal compensation can occur

Question 19

Diuretics, primary hyperaldosteronism, and bartter’s syndrome cause what kind of metabolic alkalosis?

Answer 19

chloride resistant

Question 20

what is the urine chloride cutoff for chloride resistant metabolic alkalosis?

Answer 20

> 30 mEq

Question 21

What is the urine chloride cutoff for chloride responsive metabolic alkalosis?

Answer 21

< 15 mEq

Question 22

Gastric fluid loss would cause what kind of metabolic alkalosis?

Answer 22

chloride responsive

Question 23

Vomiting, gastric aspiration, bulimia, and pyloric stenosis cause what kind of metabolic alkalosis?

Answer 23

gastric fluid loss leading to chloride responsive metabolic alkalosis