CR III - Metabolic Acidosis and Alkalosis Flashcards
What is the most common acid-base disturbance?
Metabolic acidosis
What disturbance is it if your anion gap is >30? <24?
> 30 = lactic acidosis or ketoacidosis
<24 - other
What 6 things can cause high anion gap?
Metabolic acidosis Lab error Severe volume depletion (hyperalbumin) Respirtory alkalosis Severe hyperphosphatemia Increased anionic paraproteins - IgA
What is the most common cause of a negative anion gap?
Lab error
What metabolic acidosis has a normal ion gap?
If acid accumulating in HCl
If normal plasma anion gap, what should be checked? What does a positive or negative value here mean?
Urine anion gap
Positive - renal tubular acidosis (diminished H+ secretion)
Negative - diarrhea or external loss of pancreatic/biliary secretions
Compensation for metabolic acidosis causes what shift to the oxyhemaglobin curve? What does it facilitate?
Shift to right
Favors oxygen delivery to tissues
What three cardiac responses are seen in metabolic acidosis?
Decreased contractility
Arterial vasodilation
Decreased vascular resistance
What is used to treat metabolic acidosis?
Lactate ringer
Should you extubate patients with metabolic alkalosis?
No
What should be removed if possible in someone with metabolic alkalosis?
NG tube
What 4 are saline responsive metabolic alkalosis causes? Non-responsive?
Responsive - vomiting, diuretics, posthypercapnia, Low Cl intake
Non-responsive - edema, mineralcorticoid excess, severe hypokalemia, renal failure
What is seen in Bartters syndrome? How do pts present?
Defect in Na-K-Cl
Present - hypokalemic, hypochloremic metabolic alkalosis
What is seen in Gitelmans?
Present Hypomag and hypocalecemia (due to Na-K-Cl defect)
What is seen in Liddles?
Increased Na channel activity in collecting duct
Rpesent: volume expansion, hypokalemic alkalosis, normal aldosterone
