Acid-Base - Kania

Question 1

what is a normal pH

Answer 1

7.35-7.45

Question 2

which side of the buffer system has fast compensation?

Answer 2

the lungs!! CO2 + H20

Question 3

Which side of the buffer system has slow compensation?

Answer 3

the kidneys
H+ and HCO3

Question 4

What is the normal value for PaCO2

Answer 4

40 mmHg

Question 5

What is the normal value for HCO3

Answer 5

24 MEq/L

Question 6

where is bicarbonate reabsorbed?

Answer 6

the proximal tubule in the kidney

Question 7

where does H+ excretion occur in the kidney?

Answer 7

in the distal tubule

Question 8

what is the primary change in metabolic acidosis?

Answer 8

Decreased HCO2

Question 9

what is the compensatory mechanism for metabolic acidosis?

Answer 9

decreased PaCO2

Question 10

what is the primary change in metabolic alkalosis

Answer 10

increased HCO3

Question 11

what is the compensatory mechanism in metabolic alkalosis

Answer 11

increased PaCO2

Question 12

What is the primary change in respiratory acidosis?

Answer 12

Increased PaCO2

Question 13

What is the compensatory mechanism for respiratory acidosis

Answer 13

Increased HCO3

Question 14

What is the primary change in respiratory alkalosis

Answer 14

decreased PaCO2

Question 15

what is the compensatory mechanism for respiratory alkalosis?

Answer 15

decreased HCO3

Question 15

How to identify metabolic acidosis

Answer 15

low pH, low serum HCO3, and compensatory decrease in PaCO2

Question 16

need to calculate the anion gap

Answer 16

Anion gap = Na+ - (Cl- + HCO3-)

Question 17

what is a normal anion gap?

Answer 17

3-11

Question 18

causes of non-anion gap acidosis (loss of HCO3 replaced by Cl-)

Answer 18

diarrhea, pancreatic fistulas, biliary drainage, reduced HCO3 resorptive threshold in proximal tubule, reduced renal H+ excretion, chronic renal failure, TPN

Question 19

Anion Gap Acidosis

Answer 19

MULE PAK

Question 19

what is the dosing for bicarb

Answer 19

(0.5L/kgxIBW) x (desired HCO3 - actual HCO3)

Question 20

What does MULE PAK stand for?

Answer 20

methanol intoxication, uremia, lactic acidosis, ethylene glycol, paraldehyde ingestion, aspirin, ketoacidosis

Question 20

when anion gap acidosis is confirmed, calculate a delta gap

Answer 20

patient’s anion gap - normal anion gap

Question 21

what are the causes of anion gap metabolic acidosis

Answer 21

lactic acidosis, shock, ethanol, metformin, propylene glycol, seizures, leukemia, hepatic/renal failure, diabetes, malnutrition, rhabdomyolysis, ketoacidosis, salicylate toxicity (ASA), methanol/ethylene glycol

Question 21

What do you do with a delta gap

Answer 21

Add to the patients measured HCO3- (result should be in the normal range for HCO3-) If HCO3 - is elevated, there is also metabolic acidosis present

Question 22

risks of bicarbonate administration

Answer 22

hypokalemia, hypocalcemia

Question 22

desired HCO3

Answer 22

12 mEq/L give 1/3 to 1/2 of the calculated dose and monitor

Question 23

How is metabolic acidosis characterized

Answer 23

increased pH, increased HCO3-, compensatory hypoventilation resulting in increased PaCO2

Question 24

causes of metabolic alkalosis

Answer 24

loss of acid from the GI tract, administration of bicarb, contraction alkalosis

Question 25

what is saline responsive alkalosis

Answer 25

urinary chloride <10-20 mEq/L; correcting volume fixes alkalosis

Question 26

what are the causes of saline responsive alkalosis

Answer 26

diuretics, vomiting/NG suction, lactated ringers and TPNs

Question 27

causes of saline resistant alkalosis

Answer 27

increased mineralcorticoid activity, hypokalemia, bartter's syndrome

Question 27

how is saline resistant alkalosis identified

Answer 27

urinary chloride >20

Question 28

symptoms of alkalosis

Answer 28

muscle cramps, weakness, parathesisas, aposrtural dizziness, hypoxia, confusion, coma, seizures, CV collapse, arrythmias

Question 29

treatment of saline resistant alkalosis

Answer 29

correct underlying cause; usually not urgent

Question 30

treatment of saline responsive alkalosis

Answer 30

use 1 liter NS with K supplement if needed (<4), may also use carbonic anhydrase inhibitors

Question 31

persistent metabolic alkalosis treatment

Answer 31

hydrochloric acid, ammonium chloride, arginine monohydrate

Question 32

characteristics of respiratory acidosis

Answer 32

low ph, hypercapnia >45, compensatory increase in HCO3-

Question 33

causes of respiratory acidosis

Answer 33

airway obstruction, reduced drive to breathe, PE or cardiac arrest, ALS, mech vent

Question 34

respiratory acidosis symptoms

Answer 34

SOB, dyspnea, drowsiness, HA, coma, seizures, tachycardia, arrythmias

Question 35

Treatment of respiratory acidosis

Answer 35

correct underlying cause, mech vent, may need bicarb

Question 36

characteristics of respiratory alkalosis

Answer 36

increased pH, decreased PaCO2 <40, compensatory decrease in HCO3- concentration

Question 37

cause of respiratory alkalosis

Answer 37

increased drive to breathe, mech vent, aSA intoxication

Question 38

treatment of respiratory alkalosis

Answer 38

correct the underlying cause: ventilation, sedation, paralysis