Acids Bases and electrolytes

Question 1

A condition of acid base disorder with normal pH

Answer 1

Respiratory alkalosis

Question 2

How does the body compensate for A/B imbalance?

Answer 2

Resp disorders are compensated metabolically and metabolic disorders are compensated respiratory.

Question 3

Anion Gap Equation

Answer 3

Na - (Cl- + HCO3-); normal value <11

Question 4

What protein needs to be considered in AG acidosis and how?

Answer 4

Albumin, which is decreased in many conditions (hemorrhage, inflammation, nephrotic syndrome, paraproteinemia).

Question 5

Normal ABG values

Answer 5

pH: 7.35-7.45, Bicarb: 24+/- 2, PaCO2: 35-45, PaO2: 80-100.

Question 6

MUDPILES

Answer 6

Methanol, uremia, DKA, Paraldehyde, Isoniazid/Iron/Ischemia, lactic acidosis, ethelene glycol, starvation/salicylates.

Question 7

DURHAM

Answer 7

Diarrhea, ureteral diversion, RTA, hyperalimentation, addison’s, ammonium, Misc: amphotericin B, toluene

Question 8

Winter’s formula

Answer 8

For calculating predicted change in pH for a CO2 level. pCO2= 1.5HCO3- + 8 (+/-2)

Question 9

Osmolar Gap

Answer 9

=2Na + BUN/2.8 + glucose/18. Significant if difference from measured value is >10.

Question 10

Hypotension and shock in children

Answer 10

This is a LATE finding

Question 11

Hypervolemic hypotonic hyponatremia

Answer 11

Edema in the presence of low intravascular volume. Causes: CHF, liver failure, nephrotic syndrome, hypocortisolemia, hypothyroidism.

Question 12

Euvolemic Hypotnic Hyponatremia

Answer 12

Due to pain, nausea or SIADH.

Question 13

Hypovolemic Hypotonic hyponatremia

Answer 13

extrarenal: diarrhea, burns, vomiting, sweat. Renal: diuretics, addison’s, salt wasting disease. Tx: isotonic saline over 24 hours. Caution: CPM.

Question 14

Hypotonic Hyponatremia types

Answer 14

Hypovolemic, euvolemic, hypervolemic

Question 15

Hypertonic Hyponatremia

Answer 15

Due to high levels of glucose or mannitol, causing free water into vascular compartment, diluting the Na level.

Question 16

Pseudohyponatremia

Answer 16

measurement error due to high TAGs or paraproteinemia

Question 17

Types of hyponatremia

Answer 17

Hypotonic Hyponatremia (3 types), hypertonic hyponatremia, and Pseudo/isotonic hyponatremia

Question 18

central pontine myelinolysis

Answer 18

Characterized by acute paralysis, dysphagia, dysarthria and other neurological symptoms. Most commonly caused by rapid correction of hyponatremia.

Question 19

Volume loss estimates/stages

Answer 19

1) Up to 750ml or 15%. Compensated physiologically!
2) 750-1500ml/15-30%. Tachycardia. Some delay to capp refill.
3) 1500-2000ml/30-40%. Cool, pale, clammy. Decreased urine output, Lower BP (2000ml/40%. Fast weak pulse. Altered LOC. no urine output. Hypotension to below 70 SP.

Question 20

Electrolyte of concern in someone immoblized for a fracture.

Answer 20

Calcium. This can lead to hypercalcemia, with consequent constipation, kidney problems (nephrocalcinosis, nephropathy), hypertension. Monitor urinary Ca/Cr ratio and serum Ca.

Question 21

Black kid in northern climate with no supplements presenting with fracture…

Answer 21

Rickets. Normal Ca but low serum P and high urinary P. ALP can be high.

Question 22

Fanconi Syndrome

Answer 22

Proximal rental tubular acidosis (loss bicarb). Polyuria, polydipsia, rickets/osteomalacia, acidosis, hypokalemia, hyperchloremia. Growth failure.

Question 23

Three types of dehydration (Clipp file)

Answer 23

1) Isotonic/Isonatremia: most common. vomit, diarrhea. (12 hr replace)
2) Hypotonic/Hyponatremic: drinking too much water when dehydrated. Adrenal crisis. sweating. CPM danger - 24 hr replace.
3) Hypertonic/Hypernatremic: highest mortality risk (correct over 24/48hr). Excess salt, DKA, diabetes insipitus, breast feeding failure, boiled milk/formula. (caustion=cerebral edema).