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Therapeutics > Exam 3 Metabolic Alkalosis > Flashcards

Exam 3 Metabolic Alkalosis Flashcards

1
Q

What is the PH for metabolic alkalosis? Serum HCO3? Compensatory response?

A

High PH (>7.45),

High serum HCO3 (>30)

compensatory increase in PaCO2

(High bicarb=metabolic)

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2
Q

Primary rise in HCO3 results from 3 main mechanisms. WHat are they?

A

Loss of acid from GI tract or urine
Administration of HCO3
Contraction of alkalosis (loss of Cl- rich fluid and HCO3 poor fluid)

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3
Q

What results in maintenance of metabolic alkilosis

A

impairment of renal function (impairement in renal HCO3 excretion)

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4
Q

What are the two types of metabolic alkalosis?

A

Saline responsive
Saline resistant

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5
Q

Three main causes of saline responsive alkalosis? Urinary chloride of saline responsive alkalosis

A
  1. diuretics (furosemide, torsemide, bumetadine, HCTZ)
  2. vomiting
  3. Exogenous HCO3

urinary chloride between 10-20

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6
Q

Normal PCO2 level? Normal HCO3 level? Normal PH level?

A

PaCO2- 40
HCO3- 24
PH- 7.35- 7.45

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7
Q

acid regulation controlled by

A

buffering
renal regulation
ventilatory regulation
hepatic regulation (minor)

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8
Q

Main buffers in body

A

Bicarb
phosphate
proteins

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9
Q

What important roles do the kindeys fulfil?

A

Reabsorb bicarb (mostly in proximal)
generate new bicarb (h excretion) (mostly in distal tubule)

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10
Q

When we suspect a metabolic acidosis what is the 1st step we do?

A

always calculate anion gap

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11
Q

What are causes of non anion gap metabolic acidosis

A

diarrhea- loss of HCO3
Pancreatic fistula- loss of HCO3
Type II RTA- Proximal tubule abnormality. decreased HCO3 reabsorption
Type I RTA- distal tubule abnormality, H+ secretion. Less new HCO3 made
Type IV RTA- hypoaldosteronism, leads to H+ retention
CRF- decreased H+ secretion
increased exogenous acid- TPN, HCl

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12
Q

EXAM! Anion gap metabolic acidosis causes

A

Methanol intoxication
Uremia
DIabetic ketoacidosis
Poisoning/ propylene glycol
Intoxication/infection
Lactic acidosis
ethylene glycol
salicylates/sepsis

(MUD PILES)

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13
Q

Treatment of acidosis

A

treatment of underlying cause

acute bicarb therapy for severe cases

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14
Q

When can we give acute bicarb therapy?

A

PH<7.1

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15
Q

concerns for bicarb use

A
  • Shifting oxygen-hemoglobin saturation to the left where your oxygen wants to hang on to the oxygen instead of releasing it to tissues
  • hypernatremia
  • CSF ACIDOSIS
  • electrolyte changes ( hypokalemia, decreased calcium, decreased magnesium)
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16
Q

most common cause of metabolic alkalosis

A

Diuretic

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17
Q

3 main causes of saline responsive alkalosis

A

Diuretic
vomiting
exogenous HCO3 administration or blood transfusion

18
Q

How do diuretics cause alkalosis

A

Diuretics enhance excretion of water by resulting in extracellular volume contraction

Volume contraction stimulates aldosterone

Aldosterone increases in distal tubular Na+ reabsoprtion and induces H and K secretion

H secretion is associated with HCO3 reabsorption in proximal tubule and HCO3 generation in distal tubule

19
Q

What also contributes to saline responsive alkalosis in response to diuretics

A

Hypochloremic state (they are losing Cl n addition to H20)

20
Q

What is the 2nd most common cause of saline reponsive alkalosis

A

Vomiting and NG suction

21
Q

How much mEq Cl and mEq H+ does 1 L of fluid contain

A

200 mEq Cl-
25-100 mEq H+

22
Q

Urinary chloride for saline resistant alkalosis

A

Urinary chloride >20

23
Q

Key difference between saline resistant alkalosis and saline responsive alkalosis

A

No Cl- depletion OR there is an inability to reabsorb Cl-

24
Q

causes of saline resistant alkalosis

A
  1. Increased mineralcorticoid activity (enhances Na and K+ exchange and H+ seretion)

2, hypokalemia (increased H+ secretion)

  1. renal tubular chloride wasting
25
Q

How does H+ secretion affect bicarb reabsoption and generation

A

Absorb more and making more bicarb

26
Q

What to do about mineralcorticoid induced saline resistant alkalosis

A

Dx or change to more subtle mineralcorticoid

27
Q

sx of alkalosis

A

Muscle crampsT

28
Q

Treatment of alkalosis

A

Treat underlying cause
Rapid correction is often not necessary

29
Q

Treatment of saline responsive alkalosis

A
  1. Saline (fluids/electrolytes)

1 L NS with 20-40 mEq/L Kcl over 4 hrs

  1. Carbonic anhydrase inhibitor (especially for patients that cant tolerate excess fluid or sodium)
30
Q

adverse effects of CAI

A

K+ wasting (do not use if K+ is low)

31
Q

WHen do we use HCl as treatment of akalosis

A

contraindication to Na replacement (decompensated HF, renal failure)

Failure of previous therapies or

PH>7.55

32
Q

What are adjunct treatments we always use for saline responsive alkalosis For patients with vomiting or NG suction

A

H2 antagonist or PPIs

33
Q

How to treat saline resistant alkalosis

A

-Correct hypokalemia
- reduce dose of mineralcorticoid or change to one with less mineralcorticoid activity

  • add spironolactone
  • correct hyperaldosteronism
34
Q

respiratory acidosis PH? Co2? COmpensatory mechanism?

A

Low PH <7.35

Hypercapnia >45

compensatory increase in HCO3
Almost always from failure of excretion versus overproduction

35
Q

causes of respiratory acidosis

A

-Airway obstruction
-reduced stimulus for respiration from CNS (drug OD, sleep apnea, CNS infections)
- pulmonary embolism
- mechanical ventilation

36
Q

treatment of respiratory acidosis

A

-treat underlying cause (if choking get it out)

-Mechanical ventilation or oxygen (use caution with O2 for COPD patient, shuts off their dirve to breathe)

  • avoid rapid correction to prevent alkalemia
37
Q

When do we use bicarb for respiratory acidosis

A

PH<7.15 (very rare)

38
Q

For respiratory alkalosis, what is the PH? PaCO2? Compensatory c=mechanism

A

High PH (>7.45), low PaCO2 (<40)

compensatory decrease in HCO3

39
Q

treatment of respiratory alkalosis

A

Treat underlying cause
Ventilation
Sedation
Paralysis

40
Q

symotoms of Respiratory alkalosis

A

CNS (lightheadedness, confusion, seizures)

N/V
Muscle cramps
Decreased blood flows

41
Q

symptoms of respiratory acidosis

A

Respiratory (dyspne)
CNS (HA drownsiness, confusion/coma)
CV (tachycardia, arrhythmias)

Therapeutics (36 decks)

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