Acid Base (JOhns)

Question 1

How do you evaluate respiratory compensation in metabolic alkalosis?

Answer 1

0.7 (HCO3) + 21

(+/- 2)

Greater increase = respiratory acidosis

Smaller change = respiratory ALKAlosis

Question 2

Explain what the starting bicarbonate is used for with anion gap metabolic acidosis

Answer 2

• starting bicarb is HIGHER than presented value =
  
  • metabolic alkalosis
• starting bicarb is lOWER than presented value =
  
  • metabolic acidosis

Question 3

How do you calculate respiratory compensation with metabolic acidosis?

Answer 3

• use Winter’s Formula
  
  • 1.5 (HCO3-) + 8
  • can be +/- 2
• if winters’s shows HIGHER THAN SHOULD BE = respiratory acidosis
• if winter’s shows LOWER THAN SHOULD BE =
  
  • respiratory alkalosis

Question 4

How do you evaluate metbolic compensation with acute or chronic respiratory acidosis?

Answer 4

• Acute = +1 HCO3- to every 10 CO2
• Chronic = +3 HCO3- to every 10 CO2

Question 5

How do you evaluate metabolic compensation with acute and chronic RESPIRATORY ALKALOSIS?

Answer 5

• ACUTE = -2 HCO3 to every 10 CO2
• Chronic = -5 HCO3 to every 10 CO2

Question 6

What can cause respiratory acidosis?

Answer 6

• Airway obstruction
• Lung - COPD, asthma, pneumothorax, infection
• CNS
  
  • sedatives, drugs, tumor
• neuromuscular weakness

Question 7

What can cause respiratory alkalosis?

Answer 7

• Anxiety
• aspirin, cocaine, progesterone
• tachypnea - sepsis, fever, PE, pneumonia
• hypoxia
• alcohol or narcotic withdrawal

Question 8

What can cause HIGH ANION GAP METABOLIC ACIDOSIS?

Answer 8

• Mudpiles
• M= methanol - has osmo gap
• U = uremia
• D = DKA, AKA
• P = paraldahyde
• I = iron
• L = lactic acid
• E = eythelen glycol
• S = salicylates

Question 9

What can cause normal anio gap acidosis?

Answer 9

• HARDUP
• H = post hyperventilation
• A = acid ingestion
• R = RTA
• D = diarrhea
• U = ureteral and ileal diversion
• P = pancreatic fistulas

Question 10

What can cause chloride response METABOLIC ALKALOSIS?

Answer 10

• URINE CL = < 10
  
  • VOMITING
  • diuretics
  • NG suction
  • diarrhea cuasing dehydration
  • villous atrophy

Question 11

What can cause chloride unresponsive metabolic ALKALOSIS?

Answer 11

• DUE TO HIGH ALDOSTERONE
  
  • cushings
  • hyperaldo like Barters
  • Secondary hyeraldo (CHF)
  • Bicarb ingestion

Question 12

In what situations would you find an increased osmo gap?

Answer 12

Ethylene glycol, methanol ingestions

Question 13

What do you see w/panic attack?

Answer 13

Acute RESPIRATORY ALKALOSIS

Question 14

What do you see with salicyclate overdose?

Answer 14

Acute anion gap acidosis w/respiratory alkalosis