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03. Cardiopulm Renal > Approach to Acid-Base Disorders (Selby) > Flashcards

Approach to Acid-Base Disorders (Selby) Flashcards

1
Q

definition metabolic acidosis

A

low serum HCO3-

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2
Q

definition metabolic alkalosis

A

highs serum HCO3-

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3
Q

definition respiratory acidosis

A

high PCO2

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4
Q

definition respiratory alkalosis

A

low PCO2

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5
Q

Anion gap formula

A

= Na - (HCO3 + Cl)

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6
Q

When is anion gap used?

A

to differentiate HAGMA vs.

NAGMA

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7
Q

what will falsely lower anion gap?

A

hypoalbuminemia

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8
Q

what is correction factor for anion gap with hypoalbuminemia?

A

for every 1 g/dL drop in albumin, the AG drops by 2.5 mEq/L

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9
Q

normal serum osmolality

A

275- 290 mosm/L

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10
Q

formular for serum osmolality

A

= 2(Na) + (Glucose/18) + (BUN/2.8)

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11
Q

formular for osmolar gap

A

measured serum osmolality- calculated serum osmolality

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12
Q

what is osmolar gap clinically useful for?

A
  • screening for EtOH ingestions (esp. HAGMA cases)
  • screening for ketoacidosis
  • screening for lactic acidosis
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13
Q

When is delta delta gap used for?

A

in patients with HAGMA to determine if there is coexisting NAGMA or metabolic alkalosis present

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14
Q

delta delta gap formulas

A

delta gap = calculated AG -normal AG (always 12)

delta HCO3 = normal HCO3 (always 24) - delta gap

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15
Q

what if measured HCO3 is equal to delta delta gap?

A

then no additional acid base disorder is present

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16
Q

what if measured HCO3 is greater than delta delta gap?

A

metabolic alkalosis is present in addition to HAGMA

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17
Q

what if measured HCO3 is less than delta delta gap?

A

NAGMA is present in addition to HAGMA

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18
Q

normal pH on arterial blood gas

A

pH 7.35-7.44

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19
Q

normal HCO3 on ABG

A

24 mEq/L

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20
Q

normal PCO2 on ABG

A

40 mmHg

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21
Q

normal anion gap on ABG

A

12

22
Q

normal osmolality gap on ABG

A

10 mmol/L

23
Q

Differential Dx HAGMA

A 
G- glycols (ethylene and propylene)
O- oxoproline (acetamino tox)
L- lactic acidosis (L-isomer)
D- lactic acidosis (D-isomer)
M- methanol
A- aspirin
R- renal failure
K- ketoacidosis (EtOHism, DM, starvation)
24
Q

Who is pyroglutamic (5-oxoproline) acidosis seen in?

A

women who are malnourished or critically ill

25
Q

DDx of increased osmolar gap

A 
M- methanol
E- ethanol
D- diethylene glycol
I- isopropyl EtOH
E- ethylene glycol
- propylene glycol
- keto/lactic acidosis
26
Q

what cause of increased osmolar gap is not associated with metabolic acidosis?

A

isopropyl alcohol

27
Q

What level of potassium is acidosis associated with ?

A

hyperkalemia

28
Q

what level of potassium is alkalosis associated with?

A

hypokalemia

29
Q

NAGMA DDx

A 
D- diarrhea
U- ureteral diversion
R- renal tubular acidosis
H- hyperalimentation
A- acetazolamide
A- addison's disease
M- miscellaneous (glue sniffing)
30
Q

respiratory alkalosis DDx

A

anything that increases respiratory rate or tidal volume (including pregnancy)

31
Q

respiratory acidosis DDx

A

anything that lowers respiratory rate/tidal volume, increases dead space, or worsens airway obstruction

32
Q

what is urine anion gap used for

A

clinically used to differentiate renal from nonrenal causes of NAGMA

33
Q

what is UAG a marker of

A

NH4Cl excretion, which indicates proper urinary acidification

34
Q

formula urine anion gap

A

UAG = (urine sodium + urine potassium) - urine chloride

35
Q

negative UAG meaning

A

appropriate distal nephron urinary acidification

36
Q

postive UAG meaning

A

inappropriate distal nephron urinary acidification

37
Q

problem in proximal RTA (type 2)

A

decreased capacity of proximal tubule to reabsorb HCO3, eventually some reabsorption occurs in other parts of tubule, but at a lower level (–> acidosis)

38
Q

Secretion of what leads to HCO3 reabsorption?

A

H+

39
Q

what is most common cause of RTA type 2 in children?

A

cystinosis

40
Q

Common cause of RTA type 2 in adults?

A

Fanconi syndrome (likely due to multiple myeloma)

41
Q

Problem in distal RTA (type 1)

A

patients are unable to acidify their urine; lack of net H+ ion secretion prevents urinary acidification and excretion of ammonium

42
Q

common etiologies type 1 RTA

A

Sjogren’s syndrome, glue sniffing

43
Q

clinical manifestations type 1 RTA

A

nephrolithiasis or nephrocalcinosis

44
Q

4 things for diagnosis RTA type 1

A

1) NAGMA
2) unable to acidify urine pH <5.5
3) hypokalemia, usually severe
4) UAG is positive

45
Q

Etiology hyperkalemic RTA (type 4)

A
  • deficiency circulating aldosterone
  • aldosterone resistance in collecting ducts
  • BOTH lead to impaired Na+ reabsorption by principle cells (leads to hyperkalemia)
46
Q

clinical manifestations type 4 RTA

A
  • usually asymptomatic
  • NAGMA
  • hyperkalemia
  • most patients in 50-70s with h/o DM or CKD
47
Q

Diagnosis type 4 RTA

A
  • variable urine pH (usually >5.5)

- UAG is positive

48
Q

DDx metabolic alkalosis (5 things)

A
  • hypokalemia
  • vomiting or nasogastric tube suctioning
  • diuretics (loop/thiazide)
  • volume depletion
  • mineralocorticoid excess (Conn syndrome)
49
Q

General cause of metabolic alkalosis

A

factors that stimulate Na+ reabsorption, secondarily increase H+ secretion and stimulate HCO3- reabsorption

50
Q

what cell is a mirror image of alpha intercalated cells?

A

beta intercalated

51
Q

Why is there hypochloremia with volume depletion (contraction alkalosis)?

A

The HCO3-Cl exchanger in beta intercalated cells must replete Cl- to help with HCO3- secretion

52
Q

winters formula

A

PCO2 = 1.5 [HCO3]+8 +/-2

03. Cardiopulm Renal (6 decks)

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