E3 acids and bases (very light version) Flashcards

1
Q

normal pH

A

7.35-7.45

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2
Q

pH is regulated by balance of what and what

A

bicarb and co2

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3
Q

primary buffer in the blood

A

bicarb

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4
Q

kidneys reabsorb?

A

bicarb

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5
Q

kidneys excrete?

A

H+

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6
Q

kidneys generate?

A

new bicarb

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7
Q

lungs regulate?

A

CO2 levels by adjusting ventilation

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8
Q

liver affects bicarb through?

A

protein metabolism

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9
Q

lungs compensation mechanism

A

adjusting CO2

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10
Q

metabolic or respiratory:
lungs compensation mechanism

A

metabolic

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11
Q

kidney compensation mechanism

A

altering bicarb reabsorption or H+ excretion

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12
Q

metabolic or respiratory:
kidney compensation mechanism

A

respiratory

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13
Q

low pH and low bicarb

A

metabolic acidosis

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14
Q

non-anion gap metabolic acidosis due to?

A

bicarb loss (diarrhea, renal tubule acidosis)

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15
Q

anion gap metabolic acidosis due to?

A

accumulation of acids (lactic acidosis, ketoacidosis, toxic ingestion)

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16
Q

pH where we want to treat with bicarb

A

<7.1

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17
Q

high pH, high bicarb

A

metabolic alkalosis

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18
Q

saline-responsive metabolic alkalosis often due to?

A

volume depletion (vomiting, diuretics)

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19
Q

saline responsive metabolic alkalosis responds to ___ or ____

A

sodium chloride
potassium chloride

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20
Q

treatment for metabolic alkalosis

A

consider carbonic anhydrase inhibitors (acetazolamide if fluid restriction is needed)

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21
Q

low pH, high CO2

A

respiratory acidosis

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22
Q

respiratory acidosis causes

A

hypoventilation from lung disease
cns depression
neuromucular disorders

23
Q

high pH, low CO2

A

respiratory alkalosis

24
Q

causes of respiratory alkalosis

A

hyperventilation from anxiety, pain, hypoxemia, or high altitude

25
Q

3 main things to look at to determine metabolic or respiratory

A

pH, bicarb, PaCO2

26
Q

Which of the following is the primary buffer system in the blood?
A. Phosphate buffer
B. Bicarbonate buffer
C. Protein buffer
D. Ammonia buffer

A

B

27
Q

A patient with chronic kidney disease presents with a pH of 7.31 and HCO3- of 18 mEq/L. What type of acid-base imbalance is most likely?
A. Respiratory acidosis
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis

A

C

28
Q

Which compensation mechanism would be expected in a patient with metabolic alkalosis?
A. Increased renal H+ excretion
B. Decreased renal HCO3- reabsorption
C. Hypoventilation to retain CO2
D. Hyperventilation to expel CO2

A

C

29
Q

What is a common cause of non-anion gap metabolic acidosis?
A. Lactic acidosis
B. Diabetic ketoacidosis
C. Diarrhea
D. Salicylate toxicity

A

C

30
Q

Which condition is most likely to cause respiratory alkalosis?
A. Anxiety
B. Chronic obstructive pulmonary disease (COPD)
C. Severe vomiting
D. Renal failure

A

A

31
Q

An anion gap metabolic acidosis with a high lactate level is most often associated with which condition?
A. Hyperventilation
B. Liver failure
C. Hypoxemia or shock
D. Salicylate overdose

A

C

32
Q

A patient with hypokalemia and metabolic alkalosis is found to have a urinary chloride of 15 mEq/L. Which type of alkalosis is this most consistent with?
A. Saline-responsive alkalosis
B. Saline-resistant alkalosis
C. Respiratory alkalosis
D. Mixed acid-base disorder

A

A

33
Q

In which scenario would you consider bicarbonate therapy for metabolic acidosis?
A. pH of 7.35 with normal HCO3- levels
B. pH of 7.50 with low PaCO2
C. pH < 7.10, particularly if the patient has hyperkalemia or is in cardiac arrest
D. pH of 7.25 with a normal anion gap

A

C

34
Q

Which of the following is an appropriate first-line treatment for respiratory acidosis due to opioid overdose?
A. Sodium bicarbonate infusion
B. Naloxone administration
C. Mechanical hyperventilation
D. Administration of K+ supplements

A

B

35
Q

A patient on mechanical ventilation has a pH of 7.49, PaCO2 of 25 mmHg, and HCO3- of 19 mEq/L. Which of the following acid-base disorders is most likely?
A. Metabolic alkalosis
B. Respiratory alkalosis
C. Mixed acidosis
D. Respiratory acidosis

A

B

36
Q

PaCO2 range

A

35-45 mmHg, use 40 for calculations

37
Q

bicarb range

A

22-26 mEq/L, use 24 for calculations

38
Q

anion gap formula

A

Na - (bicarb+Cl) (use the serum bicarb if given)

39
Q

anion gap range

A

3-11, use 10 for calculations

40
Q

when do you calculate delta gap?

A

when anion gap is above normal range

41
Q

delta gap formula

A

pt anion gap - normal anion gap (we use 10)

42
Q

adjusted bicarb formula

A

pt bicarb + pt delta gap

43
Q

if adjusted bicarb is within normal range (22-26) what does this mean?

A

pure anion gap metabolic acidosis with no additional metabolic disorder

44
Q

if adjusted bicarb is above the normal range (>26) what does this mean

A

indicates a mixed disorder with both an anion gap metabolic acidosis and a concurrent metabolic alkalosis

45
Q

if adjusted bicarb is below normal range (<22) what does it mean?

A

a mixed disorder with an anion gap metabolic acidosis and a concurrent non-anion gap metabolic acidosis

46
Q

MUDPILES

A

methanol
uremia
diabetes (ketoacidosis)
paraldehyde (propylene glycol)
isoniazid, iron overdose
lactic acidosis
ethylene glycol
salicylates (aspirin overdose)

47
Q

mudslip used to remember causes of?

A

anion gap metabolic acidosis

48
Q

HARDUPS

A

-Hyperalimentation (TPN w/ Cl-containing solutions
- Acetazolamide
- Renal tubular acidosis
- Diarrhea
- Ureteral diversion
- pancreatic fistula
- saline infusion

49
Q

hardups used to remember causes of?

A

non-anion gap metabolic acidosis

50
Q

shock is likely the reason for?

A

metabolic acidosis
lactic acidosis

51
Q

formula to determine what dose of bicarb to give when pH is <7.1

A

(0.5L/kg x IBW) x (desired bicarb - actual bicarb)

desired is usually set to 12

52
Q

after calculating the dose of bicarb you will be giving, what to do you make sure you do? ****

A

give 1/3 to 1/2 initially “she said this was an exam question so”

53
Q

blood transfusions can increase the risk of?

A

metabolic alkalosis