Lecture 1 Metabolic Acidosis Flashcards
low pH, low HCO3-, low PCO2 indicates _____
metabolic acidosis
high pH, high HCO3, high pCO2 indicates ____
metabolic alkalosis
low pH, high CO2, high HCO3 indicates ____
respiratory acidosis
high pH, low CO2, low HCO3 indicates ___
respiratory alkalosis
hyperventilation occurs in response to ____. hypoventilation occurs in response to _____
metabolic acidosis, metabolic alkalosis
what is the henderson hasselbalch eqation:
pH = 6.1 + log ( [HCO3] / (0.03*PCO2))
equation for anion gap?
what is it normally, according to FA
Na - (HCO3 + Cl-);
8-12 mEq
For each 1 g/dL decrease in serum ____, the expected anion gap (AG) decreases by 2.3
albumin
what is the pneumonic in FA for increased AG met acidosis?
MUDPILES
MUDPILES:
M =
U =
D =
methanol
uremia,
DKA
MUDPILES: P I L E S
propylene glycol iron/isoniazid lactic acidosos ethyele glycol salicylates (aspirin)
other causes = chronic acetaminophen, renal failure, isopropyl alcohol
most common cause of increased AG metabolic acidosis
lactic acidosis
2 forms of lactic acid:
which is a product of mammal metabolism and is measured in labs?
D-, L-Lactate;
L- lactate
Type A lactic acidosis is due to _____ of lactic acid due to _____ ie shock, hypoxemia, anemia, CO poisoning
overproduction, hypoperfusion
minor increases of Lactic acid is associated with poorer prognosis in hospital patients
diabetes, metformin use, and alcoholism are examples of type ___ lactic acidosis, ie, acidosis without overt ______
B, hypoperfusion
what should you look at before giving a patient metformin?
creatinine clearance
it causes lactic acidosis
D-lactic acidosis occurs in patients with ___ GI transit or short gut syndrome because GI ____ convert ingested carbs into D-lactic acid
slow;
bacteria
causes confusion in patients;
shows normal lactic acid on lab
early intoxication with salicylates causes _____ due to _____. later, it causes ____
resp alkalosis, CNS stimulation;
metabolic acidosis
treatment of salicylate poisining:
____ reduces protonated Aspirin.
____ causes increased excretion of aspirin.
NaHCO3;
urinary alkanization
pyroglutamic acidosis is due to chronic _____ ingestion, typically in malnourished patients
acetaminophen
in DKA, ketones can be undetected if patient has a primary _____acidosis, ie increased NADH due to concomitant ___ or lactic acidosis
beta-hydroxybutyric;
ETOH
alcoholic ketosis often presents with symptomatic ____. treatment is to give ___ which increases ____ Secretion, reducing FA breakdown to ketones
hypoglycemia,
glucose, insulin
if an alcoholic is ___ deficient, glucose given without ___ can precipitate wernicke’s encephalopathy
thiamine, B1
isopropyl alcohol poisoning causes ____, marked _____, and an _____ osmol gap but no metabolic acidosis
confusion, ketosis, increased
the osmolal gap is the _____ - the _____ osmolal mosmolal/kg
measured minus predicted (see notes for Eq)
which 2 types of AG metabolic acidosis cause an osmolal gap?
ethylene glycol and methanol
treatment of ethylene glycol and methanol poisining:
____ was the old way, ___ is a much stronger inhibitor. what do both treatments act on?
ETOH, fomepizole;
alcohol dehydrogenase
causes of metabolic acidosis with normal AG:
pneumonic is _____
HARD-ASS
HARD-ASS: H = A = R = D =
hyperalimentation
addison disease
renal tubular acidosis
diarrhea
HARD-ASS:
A
S
S
acetazolamide
spironalactone
saline infusion
Diarrhea causes metaboic acidosis due to loss of _____. Saline infusion causes dilution of ___ with Cl rich fluids.
HCO3;
HCO3
Type 1 Distal RTA:
defect in ___ cells to secrete ____, so no new HCO3 is generated. Associated with ___kalemia and kidney stones. urine pH is ____
alpha-intercalated;
H+;
hypo,
alkaline (greater than 5.5)
Type 2 proximal RTA:
defect in the PCT ___ reabsorption. Associated with ____kalemia. Urine pH is ____.
HCO3
hypo;
acidic (ie less than 5.5)
Type 4 RTA: due to hypo____ which causes ____kalemia. see a decrease in ____ excretion. urine pH is ____
aldosteronism, hyper;
NH4;
acidic (ie less than 5.5)
