metabolic acidosis

Question 1

causes of metabolic acidosis (4)

Answer 1

1. addition of acid
2. reduction/ loss of bicarbonate
3. inability to properly excrete H ions
4. inability to appropriately restore bicarbonate buffer

Question 2

some affects of chronic metabolic acidosis

Answer 2

• bone disease
• reduced albumin synthesis
• increased muscle wasting
• acceleration of kidney disease
• impaired glucose tolerance

Question 3

adverse effects of acute metabolic acidosis

Answer 3

• impaired leukocyte function
• changes in mental status
• stimulation of apoptosis

Question 4

4 homeostatic response to an acid load

Answer 4

1. immediate- extracellular buffering by HCO3
2. minutes to hours: respiratory buffering by lowering pCO2
3. two to four hr- intracellular and bone buffering
4. hours to days- increased renal H+ excretion

Question 5

how is the respiratory compensation for metabolic acidosis

Answer 5

important and rapid

Question 6

anion gap

• what is it?
• nl range

Answer 6

• measured sodium and cl- and HCO3-
• nl: 8-12
• mostly made up albumin

Question 7

addition of an organic acid; what happens to the anion gap

Answer 7

rises H+ and thus there is a drop in HCO3

• increase in anion gap

Question 8

addition of mineral acid

Answer 8

rise in H+ and there is a decrease in bicarb but there is no drop in anion gap

Question 9

examples of an organic acid

Answer 9

lactic acid, ketoacids

Question 10

examples of a mneral acid

Answer 10

hydrochloric acid

Question 11

exaplain the difference in hydrogen load btwn organic and mineral

Answer 11

• organic: there is increase in unmeasured acid but cl- stays constant
• there is an increase in cl- and a decrease in unmeasured acid

Question 12

example of a process that leads to a nl anion gap

Answer 12

• loss of bicarb due to diarrhea

Question 13

impaired acid excretion examples

Answer 13

• renal failure

- distal (type 1) RTA

Question 14

increased anion gap in mechanism of acidosis

Answer 14

• lactic acidosis
• ketoacidosis: diabetes mellitus, starvation, alcohol associated
• ingestions: aspirin, methanol
• chronic kidney disease stages 4-5

Question 15

normal anion gap in metabolic acidosis

Answer 15

• diarrhea
• early chronic kidney disease
• proximal/distal RTA
• intestinal, pancreatic or billiary fistula

Question 16

bicarb is reclaimed in

Answer 16

proximal tubular cell by CO2 intermediate

Question 17

excrete H+ ions in the form of

Answer 17

tritratable acid

Question 18

secrete H+ ions in the distal nephron to make the

Answer 18

NH3 into NH4+

Question 19

chronic kidney disease is where we have a decreased in

Answer 19

acid excretion

Question 20

what is wrong in chronic kidney disease

Answer 20

loss of functioning nephrons leads to a disruption in acid base balance where intially it is mantained by increased ammonium ecretion but eventually you see a decrease in bicarb and increase in unmeasured anion concetration

Question 21

stage 2-3 CKD we see an anion gap that is

Answer 21

normal

Question 22

stage 4-5 CKD we see an anion gap that is

Answer 22

high

Question 23

distal (type 1) renal tubular acidosis

Answer 23

inability to decrease urine pH < 5.5-6.0 due to decrease hydrogen ion secretion

Question 24

common mechanism of distal (type 1) renal tubular acidosis

Answer 24

impaired apical H+-ATPase pump

Question 25

proximal (type 2) renal tubular acidosis

Answer 25

impaired bicarb reabsorption by the proximal tubule which leads to urinary bicarb loss until the lower resportive capcity is reached and once all of the filtered bicarb is reabsorbed

Question 26

lactic acid mechanism (2)

Answer 26

1. increased lactate production: alterd redox state/pyruvate - decreased lactate utilization

Question 27

primary goal for lactic acidosis treatment

Answer 27

- restore perfusion which leads to decrease lactate production and enable hepatic metabolism of lactate to HC)3

Question 28

diabetic ketoacidosis is both a

Answer 28

insulin deficiency and glucagon excess

Question 29

consequences of Diabetic ketoacidosis

Answer 29

hyperglycemia and hyperosmolarity - wee see a loss of hypotonic fluids and loss of ketoacid anions

Question 30

treatment of diabetic ketoacidosis

Answer 30

- insulin therapy - volume resucitation - potassium replacement - careful bicarb replacement

Question 31

metabolic acidosis from diarrhea leads to

Answer 31

non-anion gap

Question 32

diarrhea treatment

Answer 32

- bicarb replacement - volume resuscitation - correction of hypokalemia and other electrolyte disturbances