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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
Q

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

A

NO

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26
Q

What can cause chloride sensitive metabolic alkalosis?

A

Vomiting, NG suction, diuretics, LR, TPN, blood

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27
Q

How do you treat chloride sensitive metabolic alkalosis?

A

With NS

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28
Q

What can cause hypertensive chloride resistant metabolic alkalosis?

A
  1. Primary hypoaldosteronism
  2. Cushing’s syndrome
  3. Pseudohyperaldosteronism
  4. Hyperreninism
  5. Congential adrenal hyperplasia
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29
Q

What can cause normotensive chloride resistant metabolic alkalosis?

A
  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)
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30
Q

What is the equation for expected PCO2 compensation in metabolic alkalosis?

A

PCO2 = 0.7 * Bicarb + 20

+/- 1.5

31
Q

If PCO2 is less than expected in metabolic alkalosis, what is also present?

A

Respiratory alkalosis

32
Q

If PCO2 is greater than expected in metabolic alkalosis, what is also present?

A

Respiratory acidosis

33
Q

What is metabolic acidosis caused by?

A

Fall in the concentration of bicarb (addition of acid or loss of bicarbonate)

34
Q

What is metabolic acidosis classified by?

A

The ANION GAP (Na - Cl + Bicarb)

35
Q

What is a normal anion gap?

36
Q

What does a high anion gap indicate?

A

Addition of an acid

37
Q

What can cause high anion gap?

A 
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
Q

What can cause a non-gap metabolic acidosis (hyperchloremic)

A

GI loss: Diarrhea, surgical drains, fistula, uterosigmoidostomy/ureteroileostomy, cholestyramine
Renal loss: Renal tubular acidosis

39
Q

What is the equation for compensation of metabolic acidosis?

A

WINTERS FORMULA!
PCO2 = (1.5 * Bicarb) + 8 (+/-2)

KNOW THIS KNOW THIS KNOW THIS

40
Q

If the PCO2 is lower than expected with winters formula, what is also present with metabolic acidosis?

A

Respiratory alkalosis

41
Q

If the PCO2 is higher than expected with winters formula, what is also present with metabolic acidosis?

A

Respiratory acidosis

42
Q

If a high anion gap acidosis is present what do you do and how?

A

Check for another metabolic disorder with either the delta/delta formula or the corrected bicarbonate formula

43
Q

What is the delta delta formula?

A

[Measured anion gap-Normal anion gap]/[Normal bicarb - Measured bicarb]

44
Q

If the delta delta equation is higher than 2 in a high anion gap metabolic acidosis, what else is present?

A

Metabolic alkalosis

45
Q

If the the delta delta equation is less than 1 in a metabolic acidosis, what does this indicate?

A

A non-gap metabolic acidosis

46
Q

What is the corrected bicarbonate equation?

A

Measured Bicarb + (anion gap -12)

47
Q

If the corrected bicarbonate equation is greater than 28 in metabolic acidosis, what does this indicate?

A

Metabolic alkalosis is present

48
Q

If the corrected bicarbonate equation is less than 22 in a metabolic acidosis, what does this indicate?

A

Non-gap metabolic acidosis is present

49
Q

How do you treat metabolic acidosis?

A

Treat underlying disorder: Antidote, dialysis, insulin, bicarbonate

50
Q

Is the urine anion gap normally slightly positive or negative?

A

Slightly positive

51
Q

In metabolic acidosis, what does the urine anion gap do?

A

Becomes negative

52
Q

If the urine anion gap remains positive, what does this inidcate? (in a non-gap acidosis)

A

Renal tubular acidosis type 1 or 4

53
Q

Where does RTA2 affect?

54
Q

What is associated with RTA-2

A

A low threshold of maximal resorption TM

55
Q

What are clinical characteristics of RTA-2?

A
  • Bicarbonate between 15-20 (cannot rise above this and keep it there)
  • Hypokalemia (bicarbonaturia and increased distal salt delivaery)
56
Q

What must you evaluate for with RTA-2?

A

Myeloma, ifosfamide use (sarcome), cystinosis

57
Q

What is Fanconi’s Syndrome?

A

Proximal tubular dysfunction

58
Q

What can be given for proximal RTA?

A
  1. Acetazolamide
  2. Diuretic
  3. Oral Bicarb
59
Q

What is type 1 distal renal tubular acidosis?

A

-Impaired hydrogen secretion, not able to acidify urine

60
Q

What are complications of type 1 distal renal tubular acidosis?

A

Stones and bone destruction

61
Q

What is the treatment for type 1 distal renal tubular acidosis?

A

Oral bicarbonate

62
Q

Male with severe diarrhea and a low pH and PCO2?

A

Metabolic acidosis

63
Q

Chron’s disease, lots of diarrhea, severe fatigue and muscle weakness

A

Metabolic acidosis

64
Q

Cirrhosis due to alcoholic liver disease?

A

Respiratory alkalosis

65
Q

Diabetes

A

Metabolic acidosis

66
Q

Pregnant

A

Respiratory alkalosis

67
Q

Diarrhea

A

Metabolic acidosis

68
Q

COPD

A

Respiratory acidosis

69
Q

Liver failure

A

Respiratory alkalosis

70
Q

Sepsis

A

Respiratory alkalosis

71
Q

When calculating winter’s formula should you use the bicarb from the metabolic panel or ABG?

A

Metabolic panel

72
Q

If someone is super drugged and has low respiration, what is their acid-base status most likely gonna reveal?

A

Respiratory acidosis

73
Q

If you have someone in respiratory acidosis from being too drugged to breathe normally, what can you give?

A

Naloxone (Narcan)

-They might need intubated too

Renal 2 (10 decks)

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