Metabolic acidosis

Question 1

What characterises metabolic acidosis?

Answer 1

Low pH and low bicarbonate < 22 mmol/L

Question 2

PaCO2 in metabolic acidosis?

Answer 2

Will be low as the compensatory mechanism is to hyperventilate

Question 3

Most important thing to remember =

Answer 3

Low bicarbonate < 22 mmol/L in metabolic acidosis

Question 4

What causes normal anion gap acidosis?

Answer 4

Loss of bicarbonate e.g. diarrhoea or from the kidney and Cl will rise to provide electroneutrality

Question 5

What is the mechanism behind a raised anion gap acidosis?

Answer 5

Gain of acid resulting in removal of bicarbonate due to formation of carbonic acid and increase in unmeasured anions to provide electroneutrality

Question 6

What does the mnemonic GOLDMARK signify?

Answer 6

All the causes of raised anion gap metabolic acidosis

Question 7

G in GOLDMARK?

Answer 7

Glycols (ethylene, propylene)

Question 8

O in GOLDMARK?

Answer 8

Oxyproline

Question 9

L in GOLDMARK?

Answer 9

Lactate

Question 10

D in GOLDMARK?

Answer 10

D-lactate

Question 11

M in GOLDMARK?

Answer 11

Methanol

Question 12

A in GOLDMARK?

Answer 12

Aspirin

Question 13

R in GOLDMARK?

Answer 13

Renal failure

Question 14

K in GOLDMARK?

Answer 14

Ketoacidosis

Question 15

What causes lactic acidosis?

Answer 15

Anaerobic respiration which occurs in shock (hypovolaemic, cariogenic, septic, anaphylactic)

Question 16

What causes ketoacidosis?

Answer 16

Ketone production and fat metabolism

Main causes are diabetes, alcohol and starvation

Question 17

What is the normal anion gap?

Answer 17

8-12 mmol/L

Question 18

Base excess normal and metabolic acidosis?

Answer 18

Normal: +/-2mEq/L

Metabolic acidosis:

Question 19

How can thiamine deficiency result in ketoacidosis?

Answer 19

Acetyl CoA from fat metabolism cannot enter the Krebs cycle