April 29, 2016 - Metabolic Acidosis

Question 1

Anion Gap and Albumin

Answer 1

Albumin is responsible for a large number of the negative charge. For every drop in serum albumin of 10, you need to add 2.5 to the acceptable AG.

Question 2

MUDPILE

Answer 2

Causes of metabolic acidosis.

Methanol

Uremia

Diabetic ketoacidosis

Paraldehyde

Infection

Lactic acidosis

Ethylene glycol

Salicylates

Question 3

Osmolar Gap

Answer 3

Estimated osmolality is 2Na + Glucose + Urea

Osmolar gap is the measured - estimated +/- 10

If greater than 10, start to be thinking of exogenous contributors to the osmolality such as toxins.

Question 4

Lactic Acidosis

Answer 4

Can be L-lactic acid (normal) or D-lactic acid (bacterial)

There are two types of L-lactic acidosis…

Type A - increased production in the presence of tissue hypoxia

Type B - increased production in the absence of tissue hypoxia

Question 5

D-Lactic Acidosis

Answer 5

Caused by bacterial overgrowth.

Question 6

L-Lactic Acidosis

Answer 6

Endogenously made lactic acid.

Type A - tissue hypoxia

Type B - absence of tissue hypoxia (mitochondrial)

Question 7

Normal Anion Gap

Answer 7

Implies a loss of buffer (bicarbonate)

Look for where the bicarbonate is being lost. Is it being lost in the GI tract or the kidneys?

Question 8

Giving Bicarbonate

Answer 8

Can have benefits such as increasing glycolysis, as well as improving cardiac and receptor function.

Can also have risks such as hypokalemia, hypocalcemia, and increased acidosis.