Acidosis and Alkalosis Flashcards
Prediction of compensatory responses to simple acid-base disturbances and pattern of changes
Steps in acid-base diagnosis
Causes of high-anion gap metabolic acidosis
Four principal causes of a high AG acidosis
- Lactic acidosis
- Ketoacidosis
- Ingested toxins
- Acute and chronic renal failure
Target HCO3 in patients with normal AG acidosis (hyperchloremic acidosis) or an AG attributable to a nonmetabolizable anion due to advanced kidney failure
22 mmol/L
Initial HCO3 goal in patients with pure AG acidosis
10-12 mmol/L and the pH to ~7.20
Initial treatment of severe acidemia (pH<7.10) in an adult patient, esp the elderly and patients with severe heart disease
IV administration of 50 meqs of Nahco3 diluted in 300 ml of sterile water over 30-45 min, during the initial 1-2h of therapy
Common cause of lactic acidosis in elderly patients
Unrecognized bowel ischemia or infarction in a patient with severe atherosclerois or cardiac decompensation receiving vasopressors
Type A Lactic Acidosis
Secondary to poor tissue perfusion
- circulatory insufficiency (shock, cardiac failure)
- Severe anemia
- Mitochondrial enzyme defects
- CO, cyanide
Type B Lactic Acidosis
Secondary to aerobic disorders
- malignancies
-nucleoside analogue reverse transcriptase inhibitors in HIV
- DM
- renal or hepatic failure
- thiamine deficiency
-severe infections (cholera, malaria)
- seizures
-drugs/toxins
Target HCO3 correction for lactic acidosis
arterial pH no more than 7.2 or the HCO3 to no more than 12 over 30-40 mins
Mainstay of treatment for diabetic ketoacidosis
IV regular insulin
Treatment for alcoholic ketoacidosis
IV administration of saline and glucose (5% dextrose in 0.9% NaCl)
Treatment for salicylate induced-acidosis
vigorous gastric lavage with isotonic saline
activated charcoal per NGT (1g/kg up to 50g)
IV NaHCo3 tx to alkalinize urine (pH >7.5)
Treatment for ethylene glycol -induced acidosis
prompt institution of saline or osmotic diuresis, thiamine and pyridoxine supplements, fomepizole, and usually hemodialysis
Causes of non-anion gap acidosis
Causes of metabolic alkalosis
Causes of respiratory acid- base disorders
