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Therapeutics I > Block 4: Acid-Base Disorders > Flashcards

Block 4: Acid-Base Disorders Flashcards

1
Q

What is the underlying cause of acid-base disorders?

A

Don’t just treat pH, you treat homeostatic imbalances

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2
Q

What is purpose of respiration?

A

Provide O2 for ATP

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3
Q

What is the equation for cellular respiration?

A

Glucose + 6 O2 → 6 CO2 + 6 H2O + 38 ATP (energy)

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4
Q

What is the equation for bicarb buffer system?

A
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5
Q

What are the variables that affect H+?

A

CO2: lungs
Bicarb: Kidneys

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6
Q

What what are ABGs? Normal values?

A

pH
PaCO2
PaO2
HCO3

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7
Q

What is the difference between alkalemia and academia?

A

Alkalosis → Alkalemia >7.45
Acidosis → Acidemia <7.35

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8
Q

What is a primary disorder?

A

Process that causes a pH shift in the direction that the pH actually shifted

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9
Q

What is compensatory response?

A

A change in either bicarb or CO2 that is in the opposite direction expected for the change in pH

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10
Q

Describe the time it takes for respiratory vs metabolic compensation?

A

Respiratory: Minutes and max comp within 24 hrs
Metabolic: 3-5 days

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11
Q

How are CO2 and HCO3 affected by acidosis?

A

↑ CO2
↓ HCO3-

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12
Q

How are CO2 and HCO3 affected by alkalosis?

A

↑ HCO3-
↓ CO2

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13
Q

In which direction would a simple respiratory acidosis move CO2?

A

UP

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14
Q

If the disorder is respiratory acidosis in which direction would metabolic compensation (after 3-5 days) move the bicarb?

A

UP

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15
Q

In which direction would a simple respiratory alkalosis move CO2?

A

Down

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16
Q

In which direction would a simple metabolic acidosis move bicarb.?

A

Down

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17
Q

If the disorder is metabolic acidosis in which direction would respiratory compensation move the CO2?

A

Down

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18
Q

In which direction would metabolic compensation for a simple respiratory alkalosis move bicarb?

A

Down

19
Q

In which direction would respiratory compensation for a simple metabolic alkalosis move CO2?

A

Up

20
Q

Describe the compensation and primary disturbances of acid base disorders?

A
21
Q

How do you calculate an anion gap?

A

[Na+] – ([Cl-] + [HCO3-])

sum all negative charges = sum all positive charges

[Na+] + All unmeasured cations = [Cl-] + [HCO3-] + all unmeasured anions

22
Q

What is the normal anion gap?

A

11-12 mol/L

23
Q

What are the steps of acid-base disorder diagnosis?

A
  1. Identify abnormalities in pH, PaCO2, and bicarbonate (ABG + electrolytes).
  2. Which abnormalities are primary and which compensatory
  3. Estimate the compensatory response.
24
Q

Describe the respiratory a-b disorder w or w/o composition? Labs?

A
25
Q

What is the general rule of a-b compensation?1

A

Compensation can not fully bring the back to normal state

26
Q

What are the rules of identifying primary abnormalities and which compensatory?

A
  1. The process consistent with the pH shift is primary
  2. Calculate anion gap: Gap > 20mmol/L - primary metabolic acidosis, regardless of pH or bicarb
  3. Calculate excess anion gap (total – normal) add that to measured bicarb. If sum > normal bicarb there is underlying metabolic alkalosis. Sum < normal bicarb there is an underlying non-anion gap metabolic acidosis.
27
Q

What are the causes of metabolic acidosis and an ↑ in anion gap?

A
  1. Lactic acidosis
  2. Kidney disease
  3. Methanol ingestion
  4. Ethylene glycol ingestion
  5. Salicylate overdose
  6. Starvation
28
Q

What are the causes of metabolic acidosis and a normal anion gap?

A
  1. GI bicarbonate loss
  2. Drugs: cholestyramine, magnesium
  3. Renal tubular acidosis
29
Q

What are the causes of metabolic alkalosis?

A
  1. Volume depletion - vomiting, nasogastric suctioning
  2. Diuretic use
  3. Hypokalemia
  4. Increased aldosterone
  5. Increased mineralocorticoids
30
Q

What would an electrolyte fishbone panel look like?

A
31
Q

What are the causes of anion gap of metabolic acidosis?

A
32
Q

What is the gold mark?

A

G – Glycols (ethylene and propylene)
O – Oxoproline
L – L-lactate
D – D-lactate
M – Methanol
A – Aspirin (salicylates)
R – Renal failure
K - Ketoacidosis

33
Q

What is acute acidosis caused by? Tx?

A

medications/ADRs, tissue hypoxia (lactic acidosis), DKA

More severe/symptomatic

Corect underlying Pathophysiology and consider dialysis or IV bicarb

34
Q

What are the causes of chronic acidosis? Treatment?

A

RTA or GI bicarb wasting

Mild/asymptomatic but bone/growth disorders

Tx: oral alkali replacement (Na vs K, Bicarb vs citrate)

35
Q

What are the complications of using just HCO3?

A

Administering exogenous HCO3 for chronic respiratory acidosis with relatively normal kidney function results in urinary excretion of the administered HCO3 without any further increase in serum HCO3 concentration

36
Q

What do the guidelines say about using HCO3 for acidosis?

A

Bicarbonate administration is **NOT ** recommended except for treatment of life-threatening hyperkalemia or for severe acidosis (pH<6.9) with evidence of compromised cardiac contractility

37
Q

How is HCO3 only recommended for cardiac arrest?

A

Related to hyperkalemia (to cause K shift) or overdose of tricyclic antidepressants

38
Q

What is the common cause of metabolic alkalosis?

A

Either Vomiting or Loop Diuretics + AKI
1. loss of H+ and Cl-
2. Injured kidneys cannot excrete enough HCO3- and Na+ to compensate
3. Vague S/Sx: patient history very important

39
Q

How do you treat metabolic alkalosis?

A
  1. NaCl fluids (increased renal perfusion and replaces lost Cl-)
  2. Acetazolamide (inhibits renal HCO3 absorption) - first line
  3. HCl or HD (severe only)
40
Q

What are some of the cause of respiratory acidosis?

A
  1. CNS depression – opiates, CNS event
  2. Neuromuscular disorders – myopathies, neuropathies
  3. Acute airway obstruction
  4. Severe pneumonia
  5. Pulmonary edema
  6. Impaired lung motion – hemothorax, pneumothorax
  7. Thoracic cage injury – flail chest
  8. Ventilator dysfunction
41
Q

What are the common causes of respiratory alkalosis?

A
  1. Progesterone
  2. Theophylline
  3. Nicotine
  4. Hypoxia
  5. Lung disease with or without hypoxia
  6. CNS disease
  7. Sepsis
  8. Hepatic encephalopathy
  9. Mechanical ventilation
42
Q

How do you use a mechanical ventilation for respiratory acid base disorders?

A

Give analgesics and sedatives, then you can control rate and depths of breaths to correct

But first you treat the underlying cause

43
Q
A

Therapeutics I (32 decks)

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