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Year 4 - Toxicology > Lecture 4 - Acid/Base Abnormalities > Flashcards

Lecture 4 - Acid/Base Abnormalities Flashcards

1
Q

Describe acidosis and alkalosis

A

processes that tend to change pH in a given direction

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2
Q

Describe academia and alkalemia

A

resultant pH of blood

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3
Q

Acid-base homeostasis maintains an arterial pH within a range of ____ to ____

A
  1. 35 to 7.45

* ideally we say 7.4 but it fluctuates

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4
Q

what pH defines acidemia

A

pH < 7.4

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5
Q

what pH defines alkalemia

A

pH > 7.4

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6
Q

What are 3 sites of acid-base regulation

A
  • chemical buffers
  • lung
  • kidney
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7
Q

What defines metabolic acidosis?

A

serum bicarbonate < 24 mEq/L

normal range 18-24 mEq/L

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8
Q

What defines metabolic alkalosis?

A

serum bicarbonate > 24 mEq/L

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9
Q

What defines respiratory acidosis?

A

pCO2 > 40 mmHg

normal range 35-45 mmHg

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10
Q

What defines respiratory alkalosis?

A

pCO2 < 40 mmHg

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11
Q

What marker for metabolic acidosis or alkalosis?

A

serum bicarbonate

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12
Q

What marker for respiratory acidosis or alkalosis?

A

pCO2

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13
Q

One primary acid-base disturbance = _____ disorder

A

simple

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14
Q

What is the major buffering system?

A

bicarbonate/carbonic acid system

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15
Q

What is pH dependent on?

A

pH is dependent on the relative ratio between carbon dioxide (acid source) and bicarbonate (base)

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16
Q

Normally, there are ___ parts of bicarbonate (HCO3-) to 1 part of carbonic acid (H2CO3)

A

20

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17
Q

If this ratio of 20:1 is altered, then what happens?

A

an acid-base abnormality!

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18
Q

Describe the respiratory regulation of CO2 elimination

A

Respiratory center: medullary chemoreceptors activated by cerebral arterial CO2

Lungs compensate for metabolic disturbances

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19
Q

if HCO3 decreases, what disorder is present?

A

metabolic acidosis

*pH will also decrease

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20
Q

Acidosis stimulates the _____ center

A

respiratory

*rate and depth of respiration increases which allows for a greater quantity of CO2 to be eliminated by the lungs

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21
Q

respiratory response to the metabolic acidosis is called a _______ _______

A

compensatory response

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22
Q

What does a compensatory response do?

A

allows for the 20:1 ratio to be closer to normal and therefore the pH is not affected as greatly

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23
Q

_____ reabsorb filtered HCO3- and eliminates H+

A

kidneys

24
Q

In the presence of respiratory acidosis, how do the kidneys compensate?

A

the kidneys excrete hydrogen ions and conserve bicarbonate ions

25
Q

In the presence of respiratory and metabolic alkalosis, how do the kidneys compensate?

A

they kidneys retain hydrogen ions and excrete bicarbonate ions

26
Q

Respiratory acidosis:

Describe compensatory response in mmol

A

For every 10mmHg increase in pCO2, HCO3 increases by 1 mmol

27
Q

Respiratory alkalosis:

Describe compensatory response in mmol

A

For every 10mmHg decrease in pCO2, HCO3 decreases by 2 mmol

28
Q

Metabolic acidosis:

Describe compensatory response in mmol

A

For every mmol decrease in HCO3, the pCO2 decreases by 1 mmHg

29
Q

Metabolic alkalosis:

Describe compensatory response in mmol

A

For every mmol increase in HCO3, the pCO2 increases by 0.7 mmHg

30
Q

What indicates the presence of a second primary acid-base disorder (i.e. a mixed acid base disturbance) ?

A

absence of expected compensatory response!

31
Q

Anion Gap allows for ____ _____ to be divided into two forms

A

metabolic acidosis

32
Q

What are the two options for anion gap for metabolic acidosis?

A
  • High Anion Gap

- Normal Anion Gap

33
Q

What is the law of electroneutrality ?

A

the net positive and negative charges of the serum must be equal

34
Q

Unmeasured cations

A

calcium and magnesium

35
Q

Unmeasured anions

A

phosphate, sulfate, albumin, ketons, and organic acids (eg. lactic acid)

36
Q

Sodium and potassium = ____% of extracellular cations

A

95

37
Q

Chloride and bicarbonate = ___% of extracellular anions

A

85

38
Q

Anion gap formula

A

AG = Na - (Cl + HCO3)

39
Q

Why is K+ taken out of anion gap formula?

A

K+ is largely intracellular cation and rarely alters the anion gap, it is often deleted from the equation of simplicity

40
Q

What is a normal anion gap

A

12 +/- 4 mEq/L

41
Q

What does a high anion gap mean?

A

increased unmeasured anions or decreased unmeasured cations

42
Q

Standard range for:

Na+

A

135-145 mEq/L

43
Q

Standard range for:

K+

A

3.5-5.0 mEq/L

44
Q

Standard range for:

Cl-

A

98-106 mEq/L

45
Q

Standard range for:

HCO3-

A

18-24 mEq/L

46
Q

Standard range for:

Lactate

A

<2 mEq/L

47
Q

Standard range for:

pCO2 (arterial)

A

35-45 mmHg

48
Q

Standard range for:

pO2 (arterial)

A

90-100 mmHg

49
Q

Standard range for:

pH

A

7.35-7.45

50
Q

Anion gap is useful to diagnose the underlying cause of ____ ______

A

metabolic acidosis

51
Q

Describe high AG metabolic acidosis

A
  • generation of an acid which titrates the bicarbonate with an unmeasured ion (ex. lactic acid)
  • chloride concentration remains normal
  • *normochloremic acidosis
52
Q

high AG metabolic acidosis = _____chloremic acidosis

A

normo

53
Q

Describe normal AG metabolic acidosis

A
  • processes that cause bicarbonate loss and chloride retention (ex. diarrhea)
  • absolute or relative chloride concentration higher than normal
  • *hyperchloremic acidosis
54
Q

normal AG metabolic acidosis = ______chloremic acidosis

A

hyper

55
Q

What are some causes of high anion gap metabolic acidosis? (normochloremic acidosis)

A
  • Renal failure (accumulation of endogenous acids)
  • Lactic acidosis
  • Ketoacidosis (diabetic, alcoholic, starvation)
  • Drugs and Toxins (salicylates, caffeine, ibuprofen, theophylline)
56
Q

What are some causes of normal anion gap metabolic acidosis? (hyperchloremic acidosis)

A

1) Drugs (acetazolamide, acidifying agents, cholestyramine)
2) Gastrointestinal bicarbonate loss (diarrhea)
3) Chloride retention (renal acidosis)

Year 4 - Toxicology (24 decks)

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