Acid Base Phys- Kleinshcmidt

Question 1

What is normal serum [Na+]?

Answer 1

140

Question 2

What is normal serum [K+]?

Answer 2

4

Question 3

What is normal serum [Cl-]?

Answer 3

108

Question 4

What is normal BUN?

Answer 4

10

Question 5

How do you calculate anion gap? What is the normal value?

Answer 5

[Na+]- (Cl + HCO3)

Normal = 12

Question 6

How do you calculate the osmol gap?

Answer 6

Measured osmol- calculated

Question 7

How do you calculate osms?

Answer 7

2[Na] + (glucose/18) + (BUN/2.8)

**usually around 285 ish

Question 8

pH 40 mmHg?

Answer 8

Respiratory Acidosis

Question 9

pH

Answer 9

Metabolic Acidosis with respiratory compensation

Question 10

pH > 7.45 and pCO2

Answer 10

Respiratory alkalosis

Question 11

pH > 7.45 and pCO2 > 40 mmHg

Answer 11

Metabolic alkalosis

Question 12

What is the primary disturbance in respiratory acidosis?

Answer 12

Increased arterial CO2 due to lack of ventilation:

airway obstruction
Acute lung disease
Chronic lung disease
Opioids, sedatives

Question 13

How do you determine the Delta Gap?

Answer 13

Calculate the excess anion gap (Calculated anion gap - 12)

Add that to the measured bicarbonate.

Should equal a normal bicarb level of ~24

If it is low, it means there is also a non anion gap acidosis. If it is high there is an underlying metabolic alkalosis.

Example: 24 - 12 = 12 (so the bicarbonate should be 12 points lower than it normally should be because a change of gap of 1 will drop the bicarbonate by an equal amount!

Question 14

What is a normal serum bicarbonate level?

Answer 14

24

Question 15

What is the compensation of a high anion gap acidosis?

Answer 15

Blow off CO2

Question 16

How can you determine the pCO2 in a high anion gap acidosis?

Answer 16

Last 2 digits of pH!

Ex. pH is 7.20 then pCO2 is 20

Question 17

What are the DDX’s of high anion gap metabolic acidosis?

Answer 17

Methanol
Uremia
DKA/AKA
Paraldahyde
Iron or INH (Isoniazid for TB tx)
Lactic acid
Ethylene glycol/ethanol
Salicylates

MUDPILES

Question 18

When would you see a normal anion gap acidosis?

Answer 18

Loss of bicarbonate from kidney of GI

Question 19

What do you see an equal rise in for the loss of bicarbonate?

Answer 19

Chloride

Question 20

What is the primary disturbance in metabolic alkalosis?

How do you compensate?

Answer 20

Increased bicarbonate

Compensate by hypoventilating

Question 21

What is acute compensation in respiratory acidosis?

Answer 21

Bicarbonate rises 1 mEq for each rise of 10 of pCO2

Question 22

What is chronic compensation in respiratory acidosis?

Answer 22

Bicarbonate rises 3 mEq for each rise of 10 pCO2

Question 23

What is acute compensation for respiratory alkalosis?

Answer 23

Bicarbonate falls 2 mEq for each drop of 10 of pCO2

Question 24

What is chronic compensation for respiratory alkalosis?

Answer 24

Bicarbonate falls by 4 mEq for each drop of 10 of pCO2