CIS Acid-Base Kirilla

Question 1

causes of hypoxia

Answer 1

hypoventilation
V/Q mismatch as seen in PE
shunting e.g. cardiac anomalies
low inspired fraction of O2
high altitude diffusion abnormalities

Question 2

for every mmHg that PaCO2 changes the ___ should change by how much and in what direction

Answer 2

pH should change by 0.8 in opposite direction

-when respiratory process

Question 3

metabolic acidosis

Answer 3

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

Question 4

causes of high anion gap

Answer 4

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

Question 5

lactic acidosis types

Answer 5

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

Question 6

normal anion gap metabolic acidosis with low HCO3 and raised Cl- (hyperchloremic metabolic acidosis)

Answer 6

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

Question 7

renal tubular acidosis

Answer 7

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)

Question 8

possible causes of type 1 RTA

Answer 8

SLE, sjogren’s, toulene

STS

Question 9

possible causes of type 2 RTA

Answer 9

multiple myeloma, heavy metal poisoning, wilson’s disease, amyloidosis

(double WHAMy)

Question 10

possible causes of type IV RTA

Answer 10

analgesic nephropathy, sickle cell disesae, SLE

ASS IV it

Question 11

in metabolic alkalosis there is a compensation in paCO2 by what

Answer 11

increase .7 for every 1 increase in HCO3

Question 12

metabolic alkalosis causes

Answer 12

cl loss or HCO3 excess

Question 13

cl loss from

Answer 13

vomiting, n/g suction, villous adenoma, diuretics

Question 14

hco3 excess from

Answer 14

enhanced hco3 resorption (hyperaldo, licorice excess)

Question 15

metabolic alkalosis causes

Answer 15

CLEVER PD

Contraction of volume
Licorice
Endocrine (conns, cushing, bartters)
Vomiting
Excess alkali
Refeeding alkalosis

Post hypercapnia
Diuretics

Question 16

2 types of metabolic alkalosis

first type

Answer 16

1) CL responsive

- urine CL

Question 17

2 types of metabolic alkalosis second type

Answer 17

CL unresponisve
Urine CL>10 mEg/L
-unresponsive to saline
-endocrine causes

Question 18

EKG and hypokalemia

Answer 18

flattened T wave then U wave/ST depression

Question 19

EKG and hyperkalemia

Answer 19

peaked T wave then widened QRS/loss of P wave

Question 20

is conn’s syndrome saline resistant

Answer 20

yes, UCL>20

Question 21

treatment for conn’s

Answer 21

if adenoma - then laparoscopic excision
if bilateral hyperplasia - spironolactone
-also correct hypokalemia

Question 22

Respiratory alkalosis causes

Answer 22

CHAMPS

CNS disease
Hypoxia
Anxiety
Mechanical ventilation
Progesterone
Salicylates/sepsis/stress

Question 23

winter equation

Answer 23

expected PCO2 = 1.5 (measured HCO3) + 8 +/-2