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Year2 Renal > Exam 3- Pales- acid base > Flashcards

Exam 3- Pales- acid base Flashcards

1
Q

what is hyperkapnia or hypokapnia

A

increased or decreased CO2 in blood

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2
Q

what is minute ventilation

A

rate by which air reaches alveoli

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3
Q

what is the quickest compensation mechanism of the body(minutes)

A

buffering

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4
Q

how long does metabolic compensation take in kidneys

A

2-3 days

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5
Q

What can cause respiratory acidosis

A

decreased RR or decreased Tidal Volume

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6
Q

what are the causes of decreased RR

A

decreased drive: drugs, coma stroke

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7
Q

what are causes of decreased tidal volume

A 
neuro-muscular disorders
severe kyphoscholiosis
ariway obstruction
COPD
obstructive sleep apnea/obesity
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8
Q

What are the types of metabolic acidosis

A

normal anion gap and high anion gap

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9
Q

what does anion gap actually mean

A

unmeasured anions in plasma: albumin, phosphate, sulfate, organic anions

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10
Q

What are causes of high anion gap metabolic acidosis

A

methanol, uremia, diabetic ketoacidosis, paraldehyde, infection, iron, isoniazide, lactic acidosis, ethylene glycol, alcohol, salicylates, starvation ketoacidosis

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11
Q

what is uremic acidosis

A

severe renal fucntion

Creatinine is less than 25

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12
Q

what causes uremic acidosis

A

decreased excretion of acids, J and decreased reabsorption of HCO3

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13
Q

what are causes of lactic acidosis

A

anaerobic metabolis: hypozemia, circulatory failure, peripheral vessel blockage, anemia
medications: metformin, some HIV meds and isoniazide
liver failure, thiamine deficiency, hypophosphatemia
sepsis and seizures

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14
Q

how do you Dx lactic acidosis

A

measuring venous or arterial

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15
Q

What causes diabetic ketoacidosis

A

insulin deficiency increases lypolysis which increase FFA to liver and increase ketone production leading to acidosis

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16
Q

how does alcohol lead to ketoacidosis

A

altered hormonal and enzymatic activities leading to ketone production

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17
Q

what is difference of diabetic ketoacidosis with alcoholic?

A

no hyperglycemia in alcoholic ketoacidosis

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18
Q

what is a normal osmol gap

A

<10

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19
Q

what is calculated osmolality

A

2 Na+ glucose/18 +BUN/2.8

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20
Q

how do you know if acidosis caused by ethanol

A

ethanol level/4.6 should be equal to the osmol gap

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21
Q

what are signs of ethylene glycol poisoning

A

metabolites hgihly toxic
increased osmol gap
Ca oxalate crystals in urine
ARF common

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22
Q

what are signs of methanol poisoning

A

found in wood alcohol and windshield fluid, causes blindess and ARF
increased osmol gap

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23
Q

what are symptoms of salicylates poisoning

A

hemorrhage, fever, nausea, vomiting, diaphoresis, tinnitus, pulmonary edema

24
Q

what are causes of normal anion gap metabolic acidosis

A

diarrhea, ileal drainage with stoma/bypasses
decrease reabsorption of HCO3 by renal tubules
Increase anion intakes
large amount to NaCl

25
Q

how does diarrhea lead to metabolic acidosis

A

loss of HCO3

unless chloride wasting diarrhea with villous adenoma

26
Q

what can cause a decrease in reabsorption of HCO3 by renal tubules

A

RTA

CA inhibitors

27
Q

what can lead to a large amount of NaCl in normal anion gap metabolic acidosis

A

“expansion acidosis” dilution of bicarb

decreased bicarb reabsorption from volume expansion

28
Q

describe RTA type I

A

distal. decreased H excretion in collecting ducts
increased Ca excretion and decreased citric acid concentration leading to kidney stone formation
increased potassium loss

29
Q

describe RTA II

A

defect in HCO3 reabsorption in proximal tubules
increased Ca in urine, but normal citric acid concentration
distal tubules ok so try to compensate urine pH( will not see a big difference from normal)
hypokalemia

30
Q

describe RTA IV

A

distal hyperkalemic
in patients with moderate chronic renal failure
insufficient aldosterone production or aldosterone tubular resistance
insufficient K excretion leads to hyperkalemia

31
Q

What is the pH in all types RTA

A

type I >5.5

type II <5.5

32
Q

what are serum K levels in types of RTA

A

I low
II low
III high

33
Q

kidney stones are assoc with which type RTA

A

I, distal

34
Q

how do you differentiate between RTA and diarrhea as cause of HCO3 loss

A

urine anion gap
if negative (more cations than anions) extrarenal loss
high level NH4
if positive (more anions than cations) renal loss
low level NH4

35
Q

What are causes of respiratory alkalosis

A

pain, anxiety, salicylates overdose, fever, sepsis, hypoxia (CHF, pneumonia, PE), mild asthma, mechanical ventilation

36
Q

what are causes of metabolic alkalosis

A

vomiting/NG suction
contraction alkalosis from increased HCO3 reabsorption
hypokalemia
recent correction chronic resp acidosis

37
Q

what are types of contraction alkalosis(increased HCO3) leading to metabolic alkalosis

A

dehydration, diuresis

38
Q

increased mineralocorticoid secretion can lead to what imbalance with potassium and what broad metabolic acid base disorder

A

hypokalemia causing metabolic alkalosis

39
Q

What are manifestations of metabolic acidoss

A

kussmaul respiration

nausea/vomiting, cardiac effects (arrhythmia and hypotension) neuro (confusion, lethargy, coma

40
Q

what are manifestations of respiratory acidosis

A

ineffective respiration/respiratory distress
cardiac effects: arrhythmia hypotension
neuro: confusion, lethargy coma(hypercapnic, CO2 narcosis)

41
Q

what are manifestations of metabolic alkalosis

A

decreased respiration
neuro: paresthesia, carpopedal spasm, confusion, seizures, dizziness, coma
weakness

42
Q

what are manifestations of respiratory alkalosis

A

hyperventilation, deep (not kussmaul)
neuro:paresthesia, dizziness
symptoms of underlying disease

43
Q

What are the 7 steps for reading ABG

A

1) look at pH above or below 7.4
2) look at HCO3 to determine if metabolic or respiratory (does it match pH)
3) determine if compensated or uncompensated, or partially
4) calculate anion cap to see if meatbolic acidosis
5) if have anion gap, calculate delta delta gap for mixed disorders
6) if metabolic look at pCO2 to determine if additional respiratory process exist
7) look at clinical picture

44
Q

How do you calculate anion gap when patient has extremley high glucose

A

add 1 Na for every 100 mg/dl glucose

45
Q

how do you calculate delta anion gap

A

(AG-10) / (24-HCO3)
if 1-1.6 only metabolic acidosis
if less than 1 concomitant non AG acidosis
>1.6 concomitant metabolic alkalsosis

46
Q

describe telling if additonal resp problem if a metabolic problem exists

A

see if pCO2 goes in same direction as pH
if same, no resp
if opp directions then additional respiratory

47
Q

what is step 1 ABG

A

alkalosis vs acidosis

48
Q

what is step 2 ABG

A

metabolic or respiratory? look at HCO3 and see if match pH

49
Q

what are the midline numbers for ABG

A

pH 7.4
pCO2 40
HCO3 24

50
Q

what is step 3 ABG

A

determine if compensated or uncompensated. Look at pH with metabolic!

51
Q

What is step 4 ABG

A

anion gap

52
Q

what is step 5 ABG

A

delta anion gap

AG-10)/(24-HCO3

53
Q

what is step 6 ABG

A

if metabolic look at pCO2 to see if goes along or not with HCO3. if so no other resp disorder
if against, another disorder
skip if primary is respiratory

54
Q

what is normal AG

A

10

55
Q

what are delta gap interpretations

A

if 1-1.6 pure high AG metabolic acidosis(no other)
if less than 1, concomitant non-AG acidosis
If more than 1.6 concomitant metabolic alkalosis

56
Q

If case is respiratory how do you calculate step 3 ABG–> compensation?

A

for each 10 mmHg increase pCO2 there is increase in HCO3
if HCO3 inc 1 mmole- no compensation
3-5 mmol– compensation

for each 10 mmHg decrease in pCO2 there is a dec in HCO3
1-1 mmol– no compensation
5 mmol compensation

Year2 Renal (20 decks)

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