E3 acids and bases (very light version)

Question 1

normal pH

Answer 1

7.35-7.45

Question 2

pH is regulated by balance of what and what

Answer 2

bicarb and co2

Question 3

primary buffer in the blood

Answer 3

bicarb

Question 4

kidneys reabsorb?

Answer 4

bicarb

Question 5

kidneys excrete?

Answer 5

H+

Question 6

kidneys generate?

Answer 6

new bicarb

Question 7

lungs regulate?

Answer 7

CO2 levels by adjusting ventilation

Question 8

liver affects bicarb through?

Answer 8

protein metabolism

Question 9

lungs compensation mechanism

Answer 9

adjusting CO2

Question 10

metabolic or respiratory:
lungs compensation mechanism

Answer 10

metabolic

Question 11

kidney compensation mechanism

Answer 11

altering bicarb reabsorption or H+ excretion

Question 12

metabolic or respiratory:
kidney compensation mechanism

Answer 12

respiratory

Question 13

low pH and low bicarb

Answer 13

metabolic acidosis

Question 14

non-anion gap metabolic acidosis due to?

Answer 14

bicarb loss (diarrhea, renal tubule acidosis)

Question 15

anion gap metabolic acidosis due to?

Answer 15

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

Question 16

pH where we want to treat with bicarb

Answer 16

<7.1

Question 17

high pH, high bicarb

Answer 17

metabolic alkalosis

Question 18

saline-responsive metabolic alkalosis often due to?

Answer 18

volume depletion (vomiting, diuretics)

Question 19

saline responsive metabolic alkalosis responds to ___ or ____

Answer 19

sodium chloride
potassium chloride

Question 20

treatment for metabolic alkalosis

Answer 20

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

Question 21

low pH, high CO2

Answer 21

respiratory acidosis

Question 22

respiratory acidosis causes

Answer 22

hypoventilation from lung disease
cns depression
neuromucular disorders

Question 23

high pH, low CO2

Answer 23

respiratory alkalosis

Question 24

causes of respiratory alkalosis

Answer 24

hyperventilation from anxiety, pain, hypoxemia, or high altitude

Question 25

3 main things to look at to determine metabolic or respiratory

Answer 25

pH, bicarb, PaCO2

Question 26

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

Answer 26

B

Question 27

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

Answer 27

C

Question 28

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

Answer 28

C

Question 29

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

Answer 29

C

Question 30

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

Answer 30

A

Question 31

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

Answer 31

C

Question 32

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

Answer 32

A

Question 33

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

Answer 33

C

Question 34

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

Answer 34

B

Question 35

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

Answer 35

B

Question 36

PaCO2 range

Answer 36

35-45 mmHg, use 40 for calculations

Question 37

bicarb range

Answer 37

22-26 mEq/L, use 24 for calculations

Question 38

anion gap formula

Answer 38

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

Question 39

anion gap range

Answer 39

3-11, use 10 for calculations

Question 40

when do you calculate delta gap?

Answer 40

when anion gap is above normal range

Question 41

delta gap formula

Answer 41

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

Question 42

adjusted bicarb formula

Answer 42

pt bicarb + pt delta gap

Question 43

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

Answer 43

pure anion gap metabolic acidosis with no additional metabolic disorder

Question 44

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

Answer 44

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

Question 45

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

Answer 45

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

Question 46

MUDPILES

Answer 46

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

Question 47

mudslip used to remember causes of?

Answer 47

anion gap metabolic acidosis

Question 48

HARDUPS

Answer 48

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

Question 49

hardups used to remember causes of?

Answer 49

non-anion gap metabolic acidosis

Question 50

shock is likely the reason for?

Answer 50

metabolic acidosis lactic acidosis

Question 51

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

Answer 51

(0.5L/kg x IBW) x (desired bicarb - actual bicarb) desired is usually set to 12

Question 52

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

Answer 52

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

Question 53

blood transfusions can increase the risk of?

Answer 53

metabolic alkalosis