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CPR Exam 3 > Approach To Acid-Base Disorders > Flashcards

Approach To Acid-Base Disorders Flashcards

1
Q

What is normal arterial pH?

A

7.35- 7.45

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2
Q

What is the normal intracellular pH?

A

7.0- 7.3

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3
Q

How do the lungs compensate metabolic acidosis?

A

They increase respiratory rate

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4
Q

How do the lungs compensate metabolic alkalosis?

A

They decrease respiratory rate

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5
Q

How do the kidneys compensate for respiratory acidosis?

A

They increase reclamation and generation of new HCO3-

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6
Q

How do the kidneys compensate for respiratory alkalosis?

A

They decrease reclamation and generation of new HCO3-

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7
Q

How do you calculate anion gap?

A

Na - (HCO3 + Cl)

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8
Q

Why is it necessary to know the anion gap?

A

It can help differentiate etiologies of metabolic acidosis, diagnose paraproteinemias, or diagnose lithium/bromide/iodide intoxications

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9
Q

What can cause normal anion-gap metabolic acidosis?

A

Hyperchloremic metabolic acidosis

Renal tubular acidosis

Diarrhea

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10
Q

How does hypoalbuminuria affect anion gap?

A

It falsely lowers it

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11
Q

What is the osmolar gap useful for?

A

Screening for alcohol ingestions (particularly in HAGMA cases) - if AG >20 = alcohol ingestion

Screening for ketoacidosis

Screening for lactic acidosis

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12
Q

What is the delta-delta gap?

A

Used in patients with HAGMA to determine if there is a coexistent NAGMA or metabolic alkalosis present

Ex) AG = 20; 8 above normal value of 12
HCO3- should be 16 (8 below normal value of 24)

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13
Q

What is the normal value for anion gap?

A

12

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14
Q

What is the normal value for osmolality gap?

A

10 mmol/L

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15
Q

What is the DDx for HAGMA?

A

G- Glycols (ethylene and propylene)
O- Oxoproline (pyroglutamic acid - from acetaminophen toxicity)
L - Lactic acidosis
D - Lactic acidosis (colonic metabolization of glucose, starch, or other carbs by bacteria; seen in short bowel syndromes)

M- Methanol
A- Aspirin
R - Renal failure
K- Ketoacidosis (Alcoholic, Diabetic, Starvation)

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16
Q

What is the DDx for people with an increased serum osmolar gap?

A 
M - methanol
E- ethanol
D- diethylene glycol (diuretic [mannitol])
I - isopropyl alcohol
E - ethylene glycol
17
Q

Is acidosis associated with hyper or hypokalemia? What about alkalosis?

A

Acidosis = hyperkalemia

Alkalosis = hypokalemia

18
Q

What is the DDx for NAGMA?

A

D- diarrhea
U- ureteral diversion (ileal conduit) or fistula
R- renal tubular acidosis
H - hyperalimentation (i.e. enteral nutrition)
A- Acetazolamide (carbonic anhydrase inhibitor)
A- Addison’s disease
M - miscellaneous (toulene toxicity - glue sniffing, pancreatic fistula, medications)

19
Q

Where is most of HCO3 reabsorbed?

A

Proximal tubule

20
Q

What is the pathophys of Proximal RTA (Type 2)?

A

There is decreased capacity in the PT to reabsorb HCO3, so the filtered HCO3 load exceeds PT reabsorptive capacity and thereby increases distal HCO3- delivery which overwhelms the reabsorption mechanisms downstream in the TAL and DT, leading to HCO3 loss in the urine and thereby a low serum HCO3

21
Q

How do you diagnose Proximal RTA (Type 2)?

A

Urine pH canbe high or low depending on serum HCO3 level

Urine anion gap can be positive or negative

22
Q

What can cause proximal (type 2) renal tubular acidosis?

A

Drugs and toxins (outdated tetracycline, gentamicin, streptomicin, lead, cadmium, mercury)

Tubulointerstitial disease (post-transplantation rejection, balkan nephropathy, medullary cystic disease)

Other (bone fibroma, osteopetrosis, paroxysmal nocturnal hemoglobinuria)

23
Q

What is a urine anion gap used for?

A

To differentiate renal from non-renal causes of NAGMA

24
Q

What is the pathophys in Distal RTA (type 1)?

A

These patients cannot acidify their urine which is due to decreased net H+ secretion in the distal nephron

This is due to abnormally permeable distal tubule and collecting duct allowing secreted H+ ions to flow back into tubular cell

25
Q

What is distal RTA (type 1) associated with?

A

Nephrolithiasis or nephrocalcinosis

And can be caused by Sjogren (or other systemic diseases) or glue sniffing

26
Q

How do you diagnosis Distal RTA (Type 1)?

A

NAGMA
Unable to acidify urine pH <5.5

Hypokalemia
UAG is +

27
Q

What is the etiology of hyperkalemic RTA (Type 4)?

A

Characterized by distal nephron dysfunction from impaired renal excretion of H+ and K+ causing a NAGMA and hyperkalemia

Caused by Deficiency of circulating alodsterone, aldosterone resistance in collecting ducts, or anything resulting in impaired NA+ reabsorption by principle cells (which leads to hyperkalemia)

28
Q

How does Na+ reabsorption lead to metabolic alkalosis?

A

Factors that stimulate Na+ reabsorption secondarily increase H+ secretion and thus stimulate HCO3- reabsorption

CPR Exam 3 (4 decks)

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