Final Quiz: Acid-Base Flashcards
Normal blood pH
7.35-7.45
Normal HCO3
22-28
Normal pCO2
35-45
Organ responsible for Bicarb
Kidney
Organ responsbile for C02
Lungs
Anion Gap equation
AG = ( Na + K ) - ( Cl + HCO3)
Anion Gap utilization
If AG > 14, suspect exogenous/endogenous factor present.
Primary disturbance in Metabolic Acidosis
Low HCO3
Primary disturbance in Respiratory Acidosis
High PaCO2
Management: Acute Resp. Acidosis
Severe - mechanical vent
Due to bronchospasm - bronchodilator
Due to overdose - antagonize
Benzodiazepine antagonist
Flumazenil
Opioid antagonist
Naloxone
Management: Chronic Resp. Acidosis
O2 only if necessary - careful
Bicarb if pH < 7.2
- Treat to pH 7.25
Management: Acute Resp. Alkylosis
Correct cause
Severe hypoxemia - Oxygen
Mechanical vent. if pH > 7.6
Management: AG Metab. Acidosis
Correct cause
Management: Non-AG Metab. Acidosis
Bicarb up to 18
Causes of Non-AG Metab. Acidosis
GI Losses, Urine-AG (-)
Renal Losses, Urine-AG (+)
- RTA
Management: Severe Metab. Acidosis
Bicarb up to 18
- pH < 7.15
- HCO3 < 5
Management: Chronic Metab. Acidosis
Treat cause
Oral bicarb. or alkali therapy
Management: Saline-responsive Metabolic Alkylosis with U [Cl] < 10
If vomiting: anti-emetic
If NG suction: put H2-blockers in there
If diuretic: D/C or lower dose
Then give NS or 1/2 NS
Management: Severe/prolonged Metabolic Alkylosis
If pH > 7.55, give ammonium-Cl
- Give HCl if life-threatening, liver disease, or can’t be dialyzed.
Urine Anion Gap Equation
AGu = ( Na,u + Ku ) - Clu
Proximal RTA: Type II
Proximal struggles to bring Bicarb. back in.
New equilibrium 15-17
Acetazolamide a big one
Distal RTA: Type I
Distal can push H+ out and bring Bicarb. in.
More mild than Type II
Acetazolamide and Amiloride big ones
Type IV RTA
Ultimately aldosterone insufficient
ACEs/ARBs, spironolactone
