Lecture 1 Metabolic Acidosis

Question 1

low pH, low HCO3-, low PCO2 indicates _____

Answer 1

metabolic acidosis

Question 2

high pH, high HCO3, high pCO2 indicates ____

Answer 2

metabolic alkalosis

Question 3

low pH, high CO2, high HCO3 indicates ____

Answer 3

respiratory acidosis

Question 4

high pH, low CO2, low HCO3 indicates ___

Answer 4

respiratory alkalosis

Question 5

hyperventilation occurs in response to ____. hypoventilation occurs in response to _____

Answer 5

metabolic acidosis, metabolic alkalosis

Question 6

what is the henderson hasselbalch eqation:

Answer 6

pH = 6.1 + log ( [HCO3] / (0.03*PCO2))

Question 7

equation for anion gap?

what is it normally, according to FA

Answer 7

Na - (HCO3 + Cl-);

8-12 mEq

Question 8

For each 1 g/dL decrease in serum ____, the expected anion gap (AG) decreases by 2.3

Answer 8

albumin

Question 9

what is the pneumonic in FA for increased AG met acidosis?

Answer 9

MUDPILES

Question 10

MUDPILES:
M =
U =
D =

Answer 10

methanol
uremia,
DKA

Question 11

MUDPILES:
P
I
L
E
S

Answer 11

propylene glycol
iron/isoniazid
lactic acidosos 
ethyele glycol
salicylates (aspirin)

other causes = chronic acetaminophen, renal failure, isopropyl alcohol

Question 12

most common cause of increased AG metabolic acidosis

Answer 12

lactic acidosis

Question 13

2 forms of lactic acid:

which is a product of mammal metabolism and is measured in labs?

Answer 13

D-, L-Lactate;

L- lactate

Question 14

Type A lactic acidosis is due to _____ of lactic acid due to _____ ie shock, hypoxemia, anemia, CO poisoning

Answer 14

overproduction, hypoperfusion

minor increases of Lactic acid is associated with poorer prognosis in hospital patients

Question 15

diabetes, metformin use, and alcoholism are examples of type ___ lactic acidosis, ie, acidosis without overt ______

Answer 15

B, hypoperfusion

Question 16

what should you look at before giving a patient metformin?

Answer 16

creatinine clearance

it causes lactic acidosis

Question 17

D-lactic acidosis occurs in patients with ___ GI transit or short gut syndrome because GI ____ convert ingested carbs into D-lactic acid

Answer 17

slow;
bacteria

causes confusion in patients;
shows normal lactic acid on lab

Question 18

early intoxication with salicylates causes _____ due to _____. later, it causes ____

Answer 18

resp alkalosis, CNS stimulation;

metabolic acidosis

Question 19

treatment of salicylate poisining:
____ reduces protonated Aspirin.
____ causes increased excretion of aspirin.

Answer 19

NaHCO3;

urinary alkanization

Question 20

pyroglutamic acidosis is due to chronic _____ ingestion, typically in malnourished patients

Answer 20

acetaminophen

Question 21

in DKA, ketones can be undetected if patient has a primary _____acidosis, ie increased NADH due to concomitant ___ or lactic acidosis

Answer 21

beta-hydroxybutyric;

ETOH

Question 22

alcoholic ketosis often presents with symptomatic ____. treatment is to give ___ which increases ____ Secretion, reducing FA breakdown to ketones

Answer 22

hypoglycemia,

glucose, insulin

Question 23

if an alcoholic is ___ deficient, glucose given without ___ can precipitate wernicke’s encephalopathy

Answer 23

thiamine, B1

Question 24

isopropyl alcohol poisoning causes ____, marked _____, and an _____ osmol gap but no metabolic acidosis

Answer 24

confusion, ketosis, increased

Question 25

the osmolal gap is the _____ - the _____ osmolal mosmolal/kg

Answer 25

measured minus predicted (see notes for Eq)

Question 26

which 2 types of AG metabolic acidosis cause an osmolal gap?

Answer 26

ethylene glycol and methanol

Question 27

treatment of ethylene glycol and methanol poisining:

____ was the old way, ___ is a much stronger inhibitor. what do both treatments act on?

Answer 27

ETOH, fomepizole;

alcohol dehydrogenase

Question 28

causes of metabolic acidosis with normal AG:

pneumonic is _____

Answer 28

HARD-ASS

Question 29

HARD-ASS:
H =
A =
R = 
D =

Answer 29

hyperalimentation
addison disease
renal tubular acidosis
diarrhea

Question 30

HARD-ASS:
A
S
S

Answer 30

acetazolamide
spironalactone
saline infusion

Question 31

Diarrhea causes metaboic acidosis due to loss of _____. Saline infusion causes dilution of ___ with Cl rich fluids.

Answer 31

HCO3;

HCO3

Question 32

Type 1 Distal RTA:
defect in ___ cells to secrete ____, so no new HCO3 is generated. Associated with ___kalemia and kidney stones. urine pH is ____

Answer 32

alpha-intercalated;
H+;
hypo,
alkaline (greater than 5.5)

Question 33

Type 2 proximal RTA:

defect in the PCT ___ reabsorption. Associated with ____kalemia. Urine pH is ____.

Answer 33

HCO3
hypo;
acidic (ie less than 5.5)

Question 34

Type 4 RTA: due to hypo____ which causes ____kalemia. see a decrease in ____ excretion. urine pH is ____

Answer 34

aldosteronism, hyper;
NH4;
acidic (ie less than 5.5)