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Acid-Base (Martucci) Flashcards

1
Q

Primary disturbance in metabolic acidosis?

A

Decrease bicarb

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2
Q

Compensatory response metabolic acidosis?

A

Decrease PCO2

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3
Q

Primary disturbance metabolic alkalosis?

A

Increase bicarb

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4
Q

Compensatory response metabolic alkalosis?

A

Increase PCO2

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5
Q

Primary disturbance respiratory acidosis?

A

Increase PCO2

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6
Q

Compensatory response respiratory acidosis?

A

Increase bicarb

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7
Q

Primary disturbance respiratory alkalosis?

A

Decrease PCO2

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8
Q

Compensatory response respiratory alkalosis?

A

Decrease bicarb

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9
Q

Respiratory acidosis (resulting from respiratory insufficiency can be caused by what 3 categories of issues?

A
  1. Suppression of central respiratory center (opiates, anesthetics, excessive O2 in COPD)
  2. ALI (ARDS, LVF, Pneumonia, Pneumothorax)
  3. Respiratory muscle failure (Guillain-Barre, Myasthenia Gravis, Severe hypokalemia, hypophosphatemia)
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10
Q

What is respiratory acidosis characterized by?

A

pH under 7.4 and a PCO2 over 40 (compensation by rise in CO2)

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11
Q

How is acute compensation of respiratory acidosis done?

A

Intracellular buffering

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12
Q

How is chronic compensation of respiratory acidosis done?

A

Renal retention of bicarb

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13
Q

How do you treat respiratory acidosis?

A

Treat underlying disorder:

  1. COPD exacerbation (steroids, ventilation, O2, antibiotics)
  2. CHF (loop diuretics, ventilation)
  3. Narcotic overdose (Naloxone)
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14
Q

Respiratory alkalosis due to hyperventilation can be caused by?

A
  1. Stimulation of respiratory center (anxiety, pain, fever, ASA, liver disease, sepsis, CNS disease,progesterone)
  2. Cardiopulmonary disease
  3. Hypoxemia
  4. Conscious control of respiration (ventilator, psyc)
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15
Q

What is respiratory alkalosis characterized by?

A

pH greater than 7.4 and a PCO2 under 40 (with compensation via decrease in CO2

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16
Q

How is acute compensation of respiratory alkalaosis done?

A

Intracellular buffering

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17
Q

How is chronic compensation of respiratory alkalosis done?

A

Renal secretion of bicarb

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18
Q

What is treatment for respiratory alkalosis?

A

Treat underlying disorder, intubate, sedate, paralyze, paper bag

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19
Q

Can you have respiratory acidosis and alkalosis?

A

NOPE… you either breathe too fast or too flow

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20
Q

Metabolic alkalosis (cased by an increase in plasma bicarb is caused by what 2 phases?

A

Generation or maintenance

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21
Q

What are causes of generation phase of metabolic alkalosis?

A
  1. Loss of H (NG suction, vomiting, vilious adenoma, excess mineralocorticoid, diuretics)
  2. Gain of bicarb (oral or IV supplements, TPN, lactated ringers, blood transfusion)
  3. Volume contraction (diuretics…increase distal NaCL delivery…negative tubular lumen and enhanced H secretion)
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22
Q

What are causes of maintenance phase of metabolic alkalosis?

A

Kidneys inability to excrete the excess bicarbonate

  1. Hypovolemia
  2. Hypokalemia
  3. Excessive mineralocorticoid
  4. Hypochloremia
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23
Q

How do you determine if 0.9% NaCl will correct metabolic alkalosis?

A

Check the urine chloride

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24
Q

If the urine chloride is under 20mEq/L will 0.9% NaCl correct it?

A

YES

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25
If the urine chloride is over 20mEq/L will 0.9% NaCl correct it?
NO
26
What can cause chloride sensitive metabolic alkalosis?
Vomiting, NG suction, diuretics, LR, TPN, blood
27
How do you treat chloride sensitive metabolic alkalosis?
With NS
28
What can cause hypertensive chloride resistant metabolic alkalosis?
1. Primary hypoaldosteronism 2. Cushing's syndrome 3. Pseudohyperaldosteronism 4. Hyperreninism 5. Congential adrenal hyperplasia
29
What can cause normotensive chloride resistant metabolic alkalosis?
1. Severe hypokalemia 2. Bartter's (defect in thick ascending limb of loop of henle characterized by low K levels, increase blood pH, and normal to low BP) 3. Milk-Alkali (hypercalcemia caused by repeated ingestion of Ca and absorbable alkali... calcium carbonate, milk, and sodium bicarb)
30
What is the equation for expected PCO2 compensation in metabolic alkalosis?
PCO2 = 0.7 * Bicarb + 20 +/- 1.5
31
If PCO2 is less than expected in metabolic alkalosis, what is also present?
Respiratory alkalosis
32
If PCO2 is greater than expected in metabolic alkalosis, what is also present?
Respiratory acidosis
33
What is metabolic acidosis caused by?
Fall in the concentration of bicarb (addition of acid or loss of bicarbonate)
34
What is metabolic acidosis classified by?
The ANION GAP (Na - Cl + Bicarb)
35
What is a normal anion gap?
5-12
36
What does a high anion gap indicate?
Addition of an acid
37
What can cause high anion gap?
``` MUDPILES M: Methanol U: Uremia D: Diabetic ketoacidosis P: Phenformin (metformin) I: Iron, isoniazid L: Lactic acidosis (shock, cellular toxins such as cyanide, or carbon monoxide) E: Ethylene glycol, ethanol S: Salicylates ```
38
What can cause a non-gap metabolic acidosis (hyperchloremic)
GI loss: Diarrhea, surgical drains, fistula, uterosigmoidostomy/ureteroileostomy, cholestyramine Renal loss: Renal tubular acidosis
39
What is the equation for compensation of metabolic acidosis?
WINTERS FORMULA! PCO2 = (1.5 * Bicarb) + 8 (+/-2) KNOW THIS KNOW THIS KNOW THIS
40
If the PCO2 is lower than expected with winters formula, what is also present with metabolic acidosis?
Respiratory alkalosis
41
If the PCO2 is higher than expected with winters formula, what is also present with metabolic acidosis?
Respiratory acidosis
42
If a high anion gap acidosis is present what do you do and how?
Check for another metabolic disorder with either the delta/delta formula or the corrected bicarbonate formula
43
What is the delta delta formula?
[Measured anion gap-Normal anion gap]/[Normal bicarb - Measured bicarb]
44
If the delta delta equation is higher than 2 in a high anion gap metabolic acidosis, what else is present?
Metabolic alkalosis
45
If the the delta delta equation is less than 1 in a metabolic acidosis, what does this indicate?
A non-gap metabolic acidosis
46
What is the corrected bicarbonate equation?
Measured Bicarb + (anion gap -12)
47
If the corrected bicarbonate equation is greater than 28 in metabolic acidosis, what does this indicate?
Metabolic alkalosis is present
48
If the corrected bicarbonate equation is less than 22 in a metabolic acidosis, what does this indicate?
Non-gap metabolic acidosis is present
49
How do you treat metabolic acidosis?
Treat underlying disorder: Antidote, dialysis, insulin, bicarbonate
50
Is the urine anion gap normally slightly positive or negative?
Slightly positive
51
In metabolic acidosis, what does the urine anion gap do?
Becomes negative
52
If the urine anion gap remains positive, what does this inidcate? (in a non-gap acidosis)
Renal tubular acidosis type 1 or 4
53
Where does RTA2 affect?
Proximal
54
What is associated with RTA-2
A low threshold of maximal resorption TM
55
What are clinical characteristics of RTA-2?
- Bicarbonate between 15-20 (cannot rise above this and keep it there) - Hypokalemia (bicarbonaturia and increased distal salt delivaery)
56
What must you evaluate for with RTA-2?
Myeloma, ifosfamide use (sarcome), cystinosis
57
What is Fanconi's Syndrome?
Proximal tubular dysfunction
58
What can be given for proximal RTA?
1. Acetazolamide 2. Diuretic 3. Oral Bicarb
59
What is type 1 distal renal tubular acidosis?
-Impaired hydrogen secretion, not able to acidify urine
60
What are complications of type 1 distal renal tubular acidosis?
Stones and bone destruction
61
What is the treatment for type 1 distal renal tubular acidosis?
Oral bicarbonate
62
Male with severe diarrhea and a low pH and PCO2?
Metabolic acidosis
63
Chron's disease, lots of diarrhea, severe fatigue and muscle weakness
Metabolic acidosis
64
Cirrhosis due to alcoholic liver disease?
Respiratory alkalosis
65
Diabetes
Metabolic acidosis
66
Pregnant
Respiratory alkalosis
67
Diarrhea
Metabolic acidosis
68
COPD
Respiratory acidosis
69
Liver failure
Respiratory alkalosis
70
Sepsis
Respiratory alkalosis
71
When calculating winter's formula should you use the bicarb from the metabolic panel or ABG?
Metabolic panel
72
If someone is super drugged and has low respiration, what is their acid-base status most likely gonna reveal?
Respiratory acidosis
73
If you have someone in respiratory acidosis from being too drugged to breathe normally, what can you give?
Naloxone (Narcan) | -They might need intubated too

Renal 2 (10 decks)

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