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Pulmonology > Clinical Acid Base > Flashcards

Clinical Acid Base Flashcards

1
Q

What value of pKa is used in the Henderson Hasselbach equation?

A

6.1

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2
Q

What is carbonic acid concentration in the blood proportional to?

A

PCO2

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3
Q

How do we estimate the carbonic acid concentration in the blood?

A

PaCO2 x 0.03

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4
Q

What is the Henderson Hasselbach equation that uses carbonic acid concentration?

A

pH = 6.1 + log10 (HCO3/0.03x PaCO2)

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5
Q

If PaCO2 decreases acutely from increased minute ventilation, and HCO3 does not change, what will happen to pH?

A

pH will increase

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6
Q

What is the trigger for renal or respiratory compensation in most scenarios?

A

serum pH

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7
Q

What is a normal pH value?

A

7.4

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8
Q

How do we calculate the anion gap?

A

Na-Cl-HCO3

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9
Q

What is the normal AG level?

A

10 mEq/L +- 2

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10
Q

What makes up the majority of the gap between anion s and cations in the AG equation?

A

serum albumin

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11
Q

An increase in unmeasured anions or a decrease in unmeasured cations would have what effect on AG?

A

it would increase the AG

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12
Q

A decrease in unmeasured anions or an increase in unmeasured cations would do what to AG?

A

lower AG

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13
Q

What should arterial bicarbonate look like compared to venous bicarbonate?

A

they should be very close if they’re not, you probably have a data issue

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14
Q

If pH is down and PaCO2 is up, what kind of acid base disturbance is this?

A

respiratory acidosis

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15
Q

if pH is up and PaCo2 is down, what kind of acid base disturbance is this?

A

respiratory alkalosis

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16
Q

In the acute setting, what should the change in pH be for the change in PaCO2?

A

0.08 pH for every 10 mmHg CO2 change

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17
Q

during respiratory acid base disturbances, how does bicarbonate change?

A

it doesn’t change more than 1-2 mEq, usually in the same direction as PaCO2

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18
Q

How does renal compensation change pH?

A

changing serum bicarb

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19
Q

if pH is down and PaCO2 is down, what is true of the acid base disturbance?

A

expected respiratory compensation of metabolic acidosis

20
Q

if pHi s up and PaCO2 is up, what is true of the acid base disturbance?

A

expected respiratory compensation of metabolic alkalosis

21
Q

How do you define metabolic alkalosis or acidosis?

A

low bicarb = acidosis high bicarb = alkalosis

22
Q

What type of acid base disturbance is this: 7.20/20(8)

A

metabolic acidosis with compensatory hyperventilation

23
Q

With expected respiratory compensation for a metabolic process, what is true of the relationship between pH and PaCO2?

A

the last 2 digits of pH = PaCO2

24
Q

For ever 1 mEq/L increase in acid, what happens to bicarbonate?

A

1 mEq/L decrease

25
Q

What is indicated by an AG > 20 mEq/L?

A

metabolic acidosis from acid accumulation (MUD PILES)

26
Q

What does MUD PILES stand for? What is it the DDx for?

A

methanol, uremia, diabetic ketoacidosis (or ketoacidosis from another cause), propylene glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates of a metabolic acidosis from acid accumulation , AG > 20

27
Q

What process is this?

A
  1. low bicarb + pH=PaCO2
  2. AG > 27

–> metabolic acidosis with acid accumulation (MUD PILES)

28
Q

What is the pneumonic for metabolic acidosis with a normal AG?

A

USED CARS

uretero-enterostomy with bicarb rich ostomy fluid, saline administration, endocrine disorders (eg, adrenal insufficiency), diarrhea, carbonic anhydrase inhibitors (acetazolamide), ammonium chloride, renal tubular acidosis, spironolactone

29
Q

What is a hyperchloremic metabolic acidosis?

A

one with a normal AG

30
Q

What is the upper limit for bicarb that limits its ability to compensate for metabolic alkalosis?

A

PaCo2 > 50

31
Q

What are the 2 types of metabolic alkalosis?

A

Chloride responsive and unresponsive

32
Q

what type of acid base disturbance is associated with contraction alkalosis?

A

chloride responsive metabolic alkalosis

33
Q

What causes chloride unresponsive metabolic alkalosis?

A

too much aldosterone

34
Q

Unless there are extra conditions, what should be true of the delta anion gap v. the delta bicarb?

A

They should be roughly equal

35
Q

If the serum bicarbonate is significantly lower than expected by the delta-delta analysis, what should be considered?

A
  1. consider a concurrent bicarbonate wasting condition (i.e., a non-elevated AG metabolic acidosis)
36
Q

If the bicarbonate is significantly higher than expected by the delta-delta analysis what should be considered?

A
  1. consider a concurrent bicarbonate excess state (i.e., a concurrent metabolic alkalosis)
37
Q

Interpret the following:

A

metabolic acidosis of the elevated AG variety with appropriate respiratory compensation. Note the delta-delta analysis: (delta AG = 27 – 10 = 17 meq/L, if this value is added to serum bicarb the result is 25 meq/L, which is in the normal range suggesting there is no other acid base disorder (namely, a there is no concurrent non elevated AG metabolic acidosis or metabolic alkalosis). Think MUD PILES.

38
Q

Interpret:

A

metabolic acidosis of the non-elevated AG variety with appropriate respiratory compensation. This is a bicarb wasted stated so think USED CARS. Note the elevated chloride. Note also a delta-delta analysis does not help: (delta AG = 9 – 10 = negative 1 meq/L, if this value is added to the serum bicarb the result is negative 7 meq/L, which is low - but you already knew that).

39
Q

Interpret:

A

metabolic alkalosis with expected respiratory compensation. Urine electrolytes and clinical data will help sort out chloride responsive vs. chloride unresponsive.

40
Q

Interpret:

A

respiratory alkalosis (pH and PaCO2 are on opposite sides of normal) and an elevated AG metabolic acidosis (MUD PILES) because AG > 20. Delta-delta does not demonstrate a concurrent non elevated AG metabolic acidosis or metabolic alkalosis (20 - 10 + 16 = 26—which is a normal “corrected” bicarbonate). This is a double acid-base disturbance (eg, aspirin intoxication, which can cause a respiratory alkalosis and elevated AG metabolic acidosis). (Note for delta-delta: 20 is the calculated AG, 10 is the normal AG and 16 is the serum bicarbonate level).

41
Q

Interpret:

A

respiratory alkalosis (pH and PaCO2 are on opposite sides of normal) and an elevated AG metabolic acidosis (MUD PILES). Delta-delta demonstrates “too much” serum bicarbonate (29 – 10 + 16 = 35therefore a metabolic alkalosis is present as well). This is a triple acid-base disturbance

42
Q

Interpret:

A

elevated anion gap metabolic acidosis with expected respiratory compensation (MUD PILES). Delta-delta demonstrates “too little” serum bicarbonate (24 – 10 + 5 = 19). Thus there is a concurrent non elevated anion gap metabolic acidosis. This is a double acid-base disturbance.

43
Q

Interpret:

A

elevated anion gap metabolic acidosis with an equally severe metabolic alkalosis. Delta-delta demonstrates too much bicarbonate (21 – 10 + 24 = 35). This is a double acid-base disturbance.

44
Q

What’s the differential for high DLCO?

A

polycythemia

DAH

L to R intracardiac shunt

Obesity

45
Q

What is on the differential for low DLCO?

A

anemia

emphysema

ILD

R to L shunt

PAH

46
Q

What is the differential for a respiratory alkalosis?

A

fever, pain, anxiety, sepsis, stimulants, PE, cirrhosis, hyperthyroid, pregnancy, and mild lung disease

Pulmonology (35 decks)

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