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ICM -- Nephrology > Metabolic Acid Base Disorders > Flashcards

Metabolic Acid Base Disorders Flashcards

1
Q

In respiratory compensation, pCO2 change is ____ time the change in HCO3

A

1.2

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2
Q

Serum H+ is maintained via lung control of ___ and renal control of ___

A

pCO2

HCO3

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3
Q

Modified Henderson Hasslebach equation says…

A

H= 24 x (pCO2/HCO3)

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4
Q

Defined levels of acidemia and alkalemia?

A

Acidemia - under 7.38

Alkalemia - over 7.44

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5
Q

What constitutes a normal anion gap

A

12 +/- 4

made of unmeasured anions-unmeasures cations

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6
Q

Losing a gm/dL of albumin has wha effect on AG

A

drops it by 2.3

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7
Q

Causes of Elevated AG metabolic acidosis

A 
Methenol
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tablets/Isoniazid
Lactic Acidosis
Ethylene Glycol
Salicylates
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8
Q

What normally happens to lactic acid

A

Converted to CO2 and water with no net acid-base effects

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9
Q

What is hyperlactatemia

A

Elevated serum lactate without acidosis

Normally below 2 mm/L, but minor elevations (as low as 0.75) are correlated wit mortality in hospital patients

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10
Q

Difference between type A and type B lactic acidosis

A

A – Overproduction of Lactic Acid

B – Inability to metabolize lactic acid

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11
Q

Mechanism/Causes of Type A Lactic Acidosis

A

Overproduction caused by
shock, hypoxemia,
profound anemia, CO,
Seizures.

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12
Q

Mechanism/Cause of Type B Lactic Acidosis

A

Liver can’t metabolize LA from mitochondrial probs
Genetic Defects, Cancer, Liver Disease
Toxins, Drugs, Diabetes

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13
Q

Important drugs associated with lactic acidosis

A 
Highly active retroviral agents
ethylene/propylene glycol, methanol
Metformin, Phenformin
Linezolid
Propafol
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14
Q

How does D-Lactic acidosis develop?

A

Slow GI transit or short gut syndromes allow GI bacteria to convert ingested carbs into organic acisa

Consider is GUT PROBLEM+CONFUSION+high AG Acidosis

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15
Q

What scenario would you expect to see propylene glycol toxicity?

A

Part of many hydrophobic meds (esp. lorazepam + diazepam) -> D-actic acidosis

Toxicity – Agitation, Coma, Seizures, Tachycardia, Hypotension

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16
Q

What scenario would you expect to see alcoholic ketosis

A

Long term alcohol use
Reduced Food Intake (vomit) –> hypoglycemia
–> lipoprotein lipase breaks down fat to FFA –>
Liver gets acetyl CoA –> Ketones

Treat with glucose + B1

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17
Q

How does Salicylate intoxication kill you?

A

ASA toxicity permeates into the brain, especially if it has been protenated

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18
Q

Treatment for Salicyclate intoxication?

A

NaHCO3
Urinary alkalinization via acetazolamide
Hemodialysis

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19
Q

Pyroglutamic acidosis is associated with…

A

Chronic acetaminophen use

Malnourishment/Chronic Illness

20
Q

What scenario would you expect isopropyl alcohol toxicity?

A

Drinking disinfectant, antifreeze, wood alcohol

Classic Case – Confusion + Ketosis
Normal blood sugar, increased osmolal gap, no acidosis

21
Q

How is plasma osmolality measured?

A

Freezing point depression

22
Q

Calculated osmolality

A

(2Na+glucose)/18 + (Urea/2.8)

23
Q

Scenario associated with methanol poisoning?

A

Methyl, Wood, or Bootleg Alcohol

Thinner for shellac or varnish, Fuel

24
Q

Progression of methanol poisoning symptoms?

A

Initially – inebriation and GI

6-30 hour latent period, then optic nerve/CNS symptoms

25
Scenario associated with ethylene glycol poisoning?
Drinking antifreeze, Suicide attempt
26
Progression of ethylene glycol poisoning
4-12 hours -- CNS/GI phase (like alcohol) 12-24 hrs -- Worse acidosis, cardio/pulm dysfxn 36-72 hours -- Oliguric Renal Failure
27
Diagnostic clue for ethylene glycol poisoning?
Flourescent crystals in urine under a Woods lamp
28
Trashy and Classy way to treat EG and M toxicity?
Trashy -- Alcohol | Classy - Fomepizole (competitive inhib. of OH-dehydrogenase)
29
Whats so bad about severe acidemia for CV system
impaired contractility, vasodilation, venoconstriction, arrythmias
30
Whats so bad about severe acidemia for respiratory system
Hyperventilation, respiratory muscle fatigue, dyspnea
31
Whats so bad about severe acidemia for metabolic activity?
Insulin resistance, Inhibition of anaerobic glycolysis, | protein degradation, decreased ATP synthesis, hyperkalemia
32
Important things to remember with bicarbonate therapy
Can cause volume expansion, hypocalcemia Hypernatremia Can cause alctic acidosis
33
Causes of metabolic acidosis with normal AG
GI loss, renal acidification defects, acid administration, resuscitate with Cl- rich IV fluids Urinary loss of anions that should be becoming HCO3
34
Causes of GI loss of HCO3
Diarrhea, loss of pancreatic/biliary secretions, surgical shortening of intestines, sevelamer
35
Cause/Effect of Proximal Renal Tubular Acidosis?
Failure to completely absorb HCO3 in PT Acidic if HCO3 is under threshold Defects in AA, P, and glucose absorption Hypokalemia, risketts
36
Cause/Effect of Distal RA?
Failure to acidify the urine and excrete H+ (as NH4) | Causes hypokalemia, hypercalciruia
37
Type 4 RTA is associated with...
DM
38
What is metabolic alkalosis?
a primary ncrease in serum HCO3 caused by loss of H+ from kidneys/gut, transient movement of H+ into cells, administration of HCO3
39
How does HCO3 lead with metabolic alkalosis
Loss of Cl and increased levels of HCO3, Contraction Alkalosis
40
Where in the kidney is HCO3 reabsorbed
1. PT Almost all | 2. DT -- regenerated from buffered H+
41
Name the five potential reasons a kidney cannot effectively maintain HCO3 in metabolic alkalosis
1. ECV reduction 2. Cl- depletion 3. Increased DT Na+ Delivery 4. Increased DT Na reabsorption 5. Renal Insufficiency
42
How might a person have concurrent metabolic alkalosis and acidosis?
Vomiting + High dose diuretics are so prevalent
43
Most common causes of metabolic alkalosis
Vomiting Loop/Thiazide Diuretics Hypokalemia (send H+ intracellular) Administration of HCO3 or a precursor
44
Metabolis alkalosis w/ urine chloride under 10 eEq/L indicates...
Renal loss of chloride or GI loss of H+ Cl-
45
Metabolis alkalosis w/ urine chloride over 10 eEq/L indicates...
Excess mineralocorticoid
46
Complications of metabolic alkalosis?
HB curve to right, Resp. depression Low Calcium, potassium, magnesium Vasoconstriction, Seizures, Delirium,
47
How to treat metabolic acidosis?
Stop underlying cuse

ICM -- Nephrology (9 decks)

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