CVPR Week 8: Acid-Base 2

Question 1

Objectives

Answer 1

Question 2

Identify

Answer 2

Question 3

Describe reabsorption of bicarbonate

Answer 3

Question 4

How much filtered bicarbonate is reabsorbed?

Answer 4

Almost all of it

Question 5

How is bicarbonate handled in the PCT?

Answer 5

Question 6

Describe the reabsorption of HCO3 and generation of new HCO3

Answer 6

Question 7

Describe metabolic acidosis

Answer 7

Question 8

what is anion gap?

Answer 8

Question 9

What are causes of high anion gap?

Answer 9

GOLDMARK

Question 10

GOLDMARK (G)

Answer 10

Glycol

• Ethylene glycol
• Propylene glycol

Question 11

GOLDMARK (O)

Answer 11

Oxoproline

• Pyroglutamic acidosis

Question 12

GOLDMARK (L)

Answer 12

L-Lactic acidosis

• septic shock

Question 13

GOLDMARK (D)

Answer 13

D-Lactic Acidosis

• Intestinal bacterial overgrowth

Question 14

GOLDMARK (M)

Answer 14

Methanol

Question 15

GOLDMARK (A)

Answer 15

Aspirin

Question 16

GOLDMARK (R)

Answer 16

Renal failure

Question 17

GOLDMARK (K)

Answer 17

Ketoacidosis

Question 18

Question 1

Question 19

How to identify non-AG metabolic acidosis or alkalosis in a patient with AG metabolic acidosis?

Answer 19

The concept of Delta-Delta

Question 20

AG AKA

Answer 20

Anion-gap

Question 21

As AG increases what happens to HCO3

Answer 21

HCO3 decreases

Question 22

For every _____ mEq increase in AG what happens to HCO3?

Answer 22

1.6 mEq increase in AG, HCO3 decreases by 1

Question 23

Δ AG =

Answer 23

Pts Ag - Normal Ag[12] = ΔAG

Question 24

ΔHCO3 =

Answer 24

Normal HCO3 [24] - Pts HCO3 = Δ HCO3

Question 25

Δ / Δ =

Answer 25

ΔAG/Δ HCO3 =Δ/Δ

Question 26

Δ/Δ principle

Answer 26

Question 27

Interpretation of Δ/Δ = 1-2

Answer 27

Pure AG metabolic Acidosis

Question 28

Explanation of Δ/Δ = 1-2

Answer 28

increase in AG explains the decrease in HCO3

Question 29

Interpretation of Δ/Δ = < 1

Answer 29

AG metabolic acidosis with a non AG metabolic acidosis

Question 30

Explanation of Δ/Δ = < 1

Answer 30

Pt’ HCO3 is less than what could have been explained by the increase in AG

Question 31

Interpretation of Δ/Δ = >2

Answer 31

AG metabolic acidosis with metabolic alkalosis

Question 32

Explanation of Δ/Δ = >2

Answer 32

Pt’HCO3 is more than what could have been explained by the increase in AG

Question 33

Question 2

Answer 33

Question 34

Question 3

Question 35

Interpretation of Δ/Δ = >2

Question 36

What is the osmolal gap?

Answer 36

The osmolal gap is a test to find out whether in the ECF, there is a substance which may be causing acidosis

Question 37

How to calculate serum osmolal gap?

Answer 37

1. Measure serum particles - measured osmolality
2. Calculate known particles
3. Osmolal gap = measures - calculated osmolality

Question 38

What is a normal osmolal gap?

Answer 38

< 10

anything greater than 10 suggests the presence of a toxic alcohol

Question 39

Question 4

Question 40

How to differentiate renal vs. Gastrointestinal loss of bicarbonate?

Answer 40

The concept of urinary anion gap

Question 41

UAG AKA

Answer 41

Urinary anion-gap

Question 42

UAG =

Answer 42

(U Na + UK) - UCl

Question 43

Question 5

Answer 43

Question 44

How do the lungs compensate for metabolic acidosis?

Answer 44

By decreasing PaCO2

Question 45

Question 6

Answer 45