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G+ Organisms and Renal > Kirila Acid Base > Flashcards

Kirila Acid Base Flashcards

1
Q

normal electrolytes: Na, K, Cl, CO2

A 
Na = 135-145 (140)
K = 3.5-5 (4)
Cl = 98-106 (103)
CO2 = 21-28 (24)
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2
Q

Anion Gap: calculation and normal values, and what it means

A

ANION GAP:

Na- (CL + HCO3) = AG

Normal: 12 +/- 2

Anion gap – reflects concentration of anions that aren’t routinely measured. (Sulfates, phosphates, acetoacetic acid, beta hydroxybutric acid)

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3
Q

Normal ABGs (pH, PaCO2, PaO2, HCO3, O2)

A 
pH  7.35 – 7.45 (7.4)
PaCO2  35 – 45 (40)
PaO2  80 – 100 (90)
HCO3  22 – 26 (24)
O2 Sat  92-100%
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4
Q

what do you request to completely evaluate acid base states: shock, low perfusion state, lactic acid level?

A

Basic metabolic panel

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5
Q

Normal O2 calculations

A

104 - (.27 x age) or 100 - (1/3 x age)

o2 naturally declines with age

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6
Q

causes of hypoxia

A

Hypoventilation

V/Q (Ventilation/Perfusion)
mismatch as seen in

Pulmonary Embolus (PE)

Shunting e.g. cardiac anomalies

Low inspired fraction of O2 (FiO2)

High altitude

Diffusion abnormalities e.g.
Alveolar Hemorrhage, Connective Tissue disorder

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7
Q

values defining Acidosis, alkalosis, hypoxia, hypercapnia, hypocapnia

A

Acidosis pH < 7.35
Alkalosis pH > 7.45

Hypoxia pO2 < 60

Hypercapnia pCO2 > 45
Hypocapnia pCO2 < 35
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8
Q

3 step approach to determining alkalosis or acidosis

A

1) is pH high or low?
2) is it respiratory or metabolic?
3) if its respiratory in nature, is it a pure respiratory process or is there a metabolic component?

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9
Q

pH and pCO2 are both elevated

A

metabolic process

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10
Q

pH and pCO2 are in opposite directions

A

respiratory process

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11
Q

in a PURE respiratory process…..

A

for each 10 mmHg change in PaCO2, the pH should move in the opposite direction by .08 (+/- .02) ((so .06-.1 ))

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12
Q

PURE Respiratory:

If PaCO2 is 30, the pH should be

A

If PaCO2 is 30 ( a decrease of 10 mmHg from 40) the pH should be 7.48 (7.4 + .08)

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13
Q

PURE Respiratory:

If PaCO2 is 60, the pH should be….

A

If PaCO2 is 60 (an increase of 20 mmHg) the pH should be 7.24 (7.4 – 2 x .08 or .16) a decrease of .16 or .08 for each 10 mmHg rise in pCO2

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14
Q

If the rule for a pure respiratory process is (meaning the pH and PaCO2 go in opposite directions but not in their respective proportions) is not consistent with the measured findings

A

“a second metabolic process is present”

referred to as a mixed process

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15
Q

metabolic acidosis with high anion gap: diagnosis

A 
Acute heart failure
Atrial Fibrillation with Rapid Ventricular Response
Hyponatremia
Azotemia
Metabolic acidosis
Mitral regurgitation
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16
Q

Metabolic acidosis: defined and causes

A

Metabolic acidosis – decrease in extracellular pH caused by a decrease in HCO3

  1. Loss of HCO3 – GIT (Gastrointestinal Tract), renal
  2. Increase Hydrogen load – DKA or lactic
  3. Decrease hydrogen excretion by kidney – uremic acidosis or RTA
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17
Q

types of metabolic acidosis

A
  1. elevated anion gap

2. normal anion gap with hyperchloremia

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18
Q

lactic acidosis: type A

A

shock, severe anemia, heart failure, CO poisoning

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19
Q

lactic acidosis type B1

A

associated with systemic disorders, DM, liver failure, spesis, seizures

20
Q

lactic acidsosis type b2

A

associated with drugs/toxins, ethanol, methanol, ethylene glycol, ASAw

21
Q

tests when metabolic acidosis is suspected

A

Echocardiogram
Lactic acid level
Cardiac Enzymes (Troponin I, CK MB)

22
Q

Treatment of the acidotic patient

A

Oxygen 2-4 liters/min N/C

IV – loop diuretic

Fluid restriction 1-1.5 L/day

Na HCO3 – cautiously (why?)

ACEI – cautiously (why?)

23
Q

Normal anion gap

A

12 +/- 2 (10-14)

24
Q

Normal anion gap met acid – what it means

A

HCO3 falls and CL rises (hyperchloremic met acid)

25
Q

HARDUPS

A

H - Hyperalimentation

A - Acid infusion, acetazolamide

R – RTA – renal loss of HCO3/or decreased H sec

D – Diarrhea – losing HCO3, K

U – Ureteral sigmoid or ileal diversion – losing HCO3 / increased CL and H resorption

P – Pancreatic fistula – losing HCO3, K

S – Spironolactone

26
Q

RTA types 1-3

A

1) Distal – decreased secretion of H+, so not getting rid of acid, ie “failure to acidify urine” – aka Type I Possible causes: SLE (Lupus), Sjögren’s, toluene

2) Proximal – decreased absorption of HCO3 , so not absorbing buffer – aka Type II
Possible causes: multiple myeloma, heavy metal poisoning, Wilson’s Disease, amyloidosis

3) Hyperkalemic RTA – Hyporenin and hypoaldosterone – decreased NH4 excretion and decreased HCO3 production – aka Type IV
Possible causes: analgesic nephropathy, sickle cell disease and SLE

27
Q

analgesic nephropathy, sickle cell disease and SLE

A

type IV normal anion gap metabolic acidosis

28
Q

multiple myeloma, heavy metal poisoning, Wilson’s Disease, amyloidosis

A

type II normal anion gap metabolic acidosis

29
Q

SLE (Lupus), Sjögren’s, toluene

A

type 1 normal anion gap metabolic acidosis

30
Q

tx for mixed high anion gap metabolic acidosis and respiratory acidosis

A

Dialysis – hemodialysis
Na HCO3
Synthyroid
Aerosol treatments with nebulizers

31
Q

tx for normal anion gap metabolic acidosis

A

IV fluids for volume restoration (careful not to give too much NaCL or N/S)
Could give fluids of ½ strength N/S with Na HCO3 and K

Rx underlying cause
Rx of CV compromise; pH <7.2, HCO3 <10

HCO3 deficit = desired HCO3 – measured HCO3 x (.5 x wt kg)

RX NaHCO3
1 amp 8.5%, 50 mEq/50cc
Tablets – 650 mg

32
Q

metabolic alkalosis

A

pH increase, HCO3 doubly increases, paCO2 increases

Compensatory paCO2 .7 increase for every 1 increase in HCO3

paCO2 = (.9 x HCO3) +9 (+/- 2)

Causes “CLEVER PD”

CL loss or HCO3 excess

Volume contraction

CL loss – vomiting, N/G suction, villous adenoma, diuretics

HCO3 excess – enhanced 
HCO3 resorption (hyperaldo, licorice excess)
33
Q

METABOLIC ALKALOSIS CAUSES “CLEVER PD”

A 
C – Contraction of volume
L –  Licorice
E – Endocrine (Conns, Cushing's, Bartters)
V – Vomiting
E – Excess Alkali
R – Refeeding alkalosis

P – Post Hypercapnia
D – Diuretics

34
Q

METABOLIC ALKALOSIS

TWO TYPES

A

chlorine reponsive and chlorine unresponsive

35
Q

cl responsive

A

one type of metabolic alkalosis

CL (Chloride) Responsive
-Urine CL < 10-20 mEq/l
-Improves with NaCl and Volume
-a decrease in Serum CL and Volume Contraction
Vomiting, NG suction, diuretics
36
Q

cl unresponsive

A

one type of metabolic alkalosis

CL (Chloride) Unresponsive
Urine CL > 10-20 mEq/l
Unresponsive to saline
Endocrine causes: Bartters, severe K depletion, hyperaldo, Cushing’s

37
Q

paCO2 =

A

paCO2 = (.9 x HCO3) +9 (+/- 2)

38
Q

Compensatory paCO2

A

Compensatory paCO2: .7 increase for every 1 increase in HCO3

39
Q

ꜜ pH. ꜜ PaCO2, ꜜꜜ HCO3

A

metabolic acidosis

40
Q

metabolic acidosis compensation

A

ꜜ paCO2 = 1.2 for ea 1 ꜜ HCO3

paCO2 = 1.5 x HCO3 + 8

paCO2 = last 2 digits of pH

paCO2 = HCO3 + 15

41
Q

↑ pH, ↑ PaCO2, ↑↑ HCO3

A

metabolic alkalosis

42
Q

metabolic alkalosis compensation

A

↑ paCO2 = .7 for each 1↑ HCO3

↑ paCO2 by 6 for each 10 ↑ in HCO3

43
Q

↓ pH, ↑ ↑ PaCO2, ↑ HCO3

A

respiratory acidosis

44
Q

respiratory acidosis compensation

A

↑ HCO3 = 1 for ea 10 ↑ paCO2

pH ↓ by .08 for ea 10 ↑ paCO2

45
Q

conn’s syndrome

A

Primary Hyperaldosteronism
Mineralocorticoid excess
Saline resistant (UCL >20)
Increased HCO3 excretion in urine

46
Q

drugs, CVA, Neuromuscular Airway obstruction, pneumonia, Pulmonary edema, pneumothorax, pleural disease, COPD, restrictive disease (disorders of the chest wall, resp. muscles)

A

cause hypoventilation–> resp acidosis

47
Q

hyperventilation causes and mnemonic

A 
Septic – pyelonephritis, renal abscess
Hyperthyroid
Anxiety – biochemistry test
Pain/fever
Respiratory hyperventilation may also be due to infection (sepsis)
C – CNS disease
H – Hypoxia
A – Anxiety
M – Mechanical Ventilation
P – Progesterone
S – Salicylates/Sepsis/Stress

G+ Organisms and Renal (17 decks)

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