Metabolic Acidosis/Alkalosis Flashcards
pH to H conc.
- 1 = 80
- 4 = 40
- 7 = 20
Predicted compensation for metabolic disorders
- In metabolic acidosis, 1.2 x change in HCO3 (what Bicard should be minus what it is)
- In metabolic alkalosis, 0.7 x change in HCO3
Anion Gap
Na - (HCO3 + Cl)
Normal = 10 - 12
Mnemonic : Causes of Metabolic Acidosis with elevated Anion Gap (MUDPILES)
- Methanol
- Uremia
- Diabetic ketoacidosis
- Propylene glycol
- Iron Tablets or Isoniazid
- Lactic Acidosis
- Ethylene glycol
- Salicylates (late)
Mnemonic : Causes of Metabolic Acidosis with normal Anion Gap (HARD-ASS)
- Hyperalimentation
- Addison’s disease
- Renal Tubular Acidosis
- Diarrhea
- Acetazolamide
- Spironolactone
- Saline Infusion
Treatment of Metabolic Acidosis
- Treat underlying cause
- Bicarbonate (especially with normal anion gap)
Metabolic alkalosis via GI loss
vomiting
Metabolic alkalosis via renal loss
excess mineralocorticoid hormone effect
Metabolic alkalosis via shift into cells
- severe potassium deficiency
- potassium comes of cells in exchange for hydrogen
Metabolic alkalosis from loss of chloride via GI
- secretion of chloride into stool (villous adenoma)
- failure of gut reabsorption (congenital chloridorrhea
Metabolic alkalosis from loss of chloride via renal
- Diuretics
- Bartter’s syndrome = endogenous loop diuretic (no Na-K-2Cl cotransporter)
- Gitelman’ syndrome = endogenous thiazide (no Na-Cl cotransporter)
Metabolic alkalosis from loss of chloride via skin
cystic fibrosis = loss of chloride in excess of bicarbonate in sweat
Maintenance of metabolic alkalosis
- ECF depletion
- Chloride depletion
- K+ depletion
- Hypercapnea (inc. PCO2)
Signs and symptoms of Metabolic Alkalosis
- no symptoms (maybe cramps)
- signs = hypertension, hypoventilation, tetany, increased DTR (dec. calcium), cardiac arrhythmias
What does a urinary chloride value of less than 10 indicate?
volume/chloride depletion
