CIS Acid-Base Kirilla Flashcards
causes of hypoxia
hypoventilation V/Q mismatch as seen in PE shunting e.g. cardiac anomalies low inspired fraction of O2 high altitude diffusion abnormalities
for every mmHg that PaCO2 changes the ___ should change by how much and in what direction
pH should change by 0.8 in opposite direction
-when respiratory process
metabolic acidosis
decrease in extracellular pH caused by decrease in HC03
1) loss of HC)3- GI tract, renal
2) increase hydrogen load - DKA or lactic
3) decrease hydrogen excretion by kidney -uremic acidosis or RTA
causes of high anion gap
Methanol
Uremia (increaseed bun, creatinine, sulfates, phospate)
DKA: incrased glucose, starvation, alcohol abuse
acetoacetic acid, B-hydroxybutryic acid
Paraldehyde (reagent used in lab)
I: INH, iron
L- lactic acid, shock, sepsis, low perfusion, runners
E- ethylene glycol glycolic (antifreeze)
S- salicylates
CCAT- CO, Cyanide, Alcohol, Toluene
lactic acidosis types
Type A: tissue hypoxia- shock, severe anemia, heart failure, CO poisoning
Type B1: (associated with systemic disorders) DM, liver failure, sepsis, seizures
Type B2: (associated with drugs/toxins) ethanol, methanol ethylene glycol, ASA
Type B3 (inborn errors metab,) G6PD deficiency
normal anion gap metabolic acidosis with low HCO3 and raised Cl- (hyperchloremic metabolic acidosis)
HARDUPS
H- hyperalimentation (pt with long term nutritional support via central line placement
A- acid infusion, acetazolamide
R- (renal tubular acidosis)- renal loss of HCO3- or decreased H+ secretion
D- diarrhea - lose of HCO3-, decreased K+
U- ureteral sigmoid or ileal diversion - losing HCO3/inc CL and H resorption
P- pancreatic fistula - lose HCO3-, lose K
Spironolactone
renal tubular acidosis
1) distal - decreased secretion of H+, so not getting rid of acid, ie failure to acidify urine (type 1)
2) proximal - decreased absorption of HCO3, so not absorbing buffer - aka type II
3) hyperkalemic RTA - hyporenin and hypoaldosterone, decreased NH4 excretion and decreased HCO3 production (type IV)
possible causes of type 1 RTA
SLE, sjogren’s, toulene
STS
possible causes of type 2 RTA
multiple myeloma, heavy metal poisoning, wilson’s disease, amyloidosis
(double WHAMy)
possible causes of type IV RTA
analgesic nephropathy, sickle cell disesae, SLE
ASS IV it
in metabolic alkalosis there is a compensation in paCO2 by what
increase .7 for every 1 increase in HCO3
metabolic alkalosis causes
cl loss or HCO3 excess
cl loss from
vomiting, n/g suction, villous adenoma, diuretics
hco3 excess from
enhanced hco3 resorption (hyperaldo, licorice excess)
metabolic alkalosis causes
CLEVER PD
Contraction of volume Licorice Endocrine (conns, cushing, bartters) Vomiting Excess alkali Refeeding alkalosis
Post hypercapnia
Diuretics
2 types of metabolic alkalosis
first type
1) CL responsive
- urine CL
2 types of metabolic alkalosis second type
CL unresponisve
Urine CL>10 mEg/L
-unresponsive to saline
-endocrine causes
EKG and hypokalemia
flattened T wave then U wave/ST depression
EKG and hyperkalemia
peaked T wave then widened QRS/loss of P wave
is conn’s syndrome saline resistant
yes, UCL>20
treatment for conn’s
if adenoma - then laparoscopic excision
if bilateral hyperplasia - spironolactone
-also correct hypokalemia
Respiratory alkalosis causes
CHAMPS
CNS disease Hypoxia Anxiety Mechanical ventilation Progesterone Salicylates/sepsis/stress
winter equation
expected PCO2 = 1.5 (measured HCO3) + 8 +/-2
