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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
Q

Scenario associated with ethylene glycol poisoning?

A

Drinking antifreeze, Suicide attempt

26
Q

Progression of ethylene glycol poisoning

A

4-12 hours – CNS/GI phase (like alcohol)
12-24 hrs – Worse acidosis, cardio/pulm dysfxn
36-72 hours – Oliguric Renal Failure

27
Q

Diagnostic clue for ethylene glycol poisoning?

A

Flourescent crystals in urine under a Woods lamp

28
Q

Trashy and Classy way to treat EG and M toxicity?

A

Trashy – Alcohol

Classy - Fomepizole (competitive inhib. of OH-dehydrogenase)

29
Q

Whats so bad about severe acidemia for CV system

A

impaired contractility, vasodilation, venoconstriction, arrythmias

30
Q

Whats so bad about severe acidemia for respiratory system

A

Hyperventilation, respiratory muscle fatigue, dyspnea

31
Q

Whats so bad about severe acidemia for metabolic activity?

A

Insulin resistance, Inhibition of anaerobic glycolysis,

protein degradation, decreased ATP synthesis, hyperkalemia

32
Q

Important things to remember with bicarbonate therapy

A

Can cause volume expansion, hypocalcemia
Hypernatremia
Can cause alctic acidosis

33
Q

Causes of metabolic acidosis with normal AG

A

GI loss, renal acidification defects,
acid administration, resuscitate with Cl- rich IV fluids
Urinary loss of anions that should be becoming HCO3

34
Q

Causes of GI loss of HCO3

A

Diarrhea, loss of pancreatic/biliary secretions, surgical shortening of intestines, sevelamer

35
Q

Cause/Effect of Proximal Renal Tubular Acidosis?

A

Failure to completely absorb HCO3 in PT
Acidic if HCO3 is under threshold
Defects in AA, P, and glucose absorption
Hypokalemia, risketts

36
Q

Cause/Effect of Distal RA?

A

Failure to acidify the urine and excrete H+ (as NH4)

Causes hypokalemia, hypercalciruia

37
Q

Type 4 RTA is associated with…

A

DM

38
Q

What is metabolic alkalosis?

A

a primary ncrease in serum HCO3 caused by loss of H+ from kidneys/gut, transient movement of H+ into cells, administration of HCO3

39
Q

How does HCO3 lead with metabolic alkalosis

A

Loss of Cl and increased levels of HCO3, Contraction Alkalosis

40
Q

Where in the kidney is HCO3 reabsorbed

A
  1. PT Almost all

2. DT – regenerated from buffered H+

41
Q

Name the five potential reasons a kidney cannot effectively maintain HCO3 in metabolic alkalosis

A
  1. ECV reduction
  2. Cl- depletion
  3. Increased DT Na+ Delivery
  4. Increased DT Na reabsorption
  5. Renal Insufficiency
42
Q

How might a person have concurrent metabolic alkalosis and acidosis?

A

Vomiting + High dose diuretics are so prevalent

43
Q

Most common causes of metabolic alkalosis

A

Vomiting
Loop/Thiazide Diuretics
Hypokalemia (send H+ intracellular)
Administration of HCO3 or a precursor

44
Q

Metabolis alkalosis w/ urine chloride under 10 eEq/L indicates…

A

Renal loss of chloride or GI loss of H+ Cl-

45
Q

Metabolis alkalosis w/ urine chloride over 10 eEq/L indicates…

A

Excess mineralocorticoid

46
Q

Complications of metabolic alkalosis?

A

HB curve to right, Resp. depression
Low Calcium, potassium, magnesium
Vasoconstriction, Seizures, Delirium,

47
Q

How to treat metabolic acidosis?

A

Stop underlying cuse

ICM -- Nephrology (9 decks)

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