Part 4 acid base

Question 1

________________

related to volume-mediated processes (sodium chloride- responsive)

urinary chloride concentration less than 10mEq/L

Answer 1

Sodium chloride- responsive metabolic alkalosis

Question 2

Causes of sodium-responsive metabolic alkalosis

Causes
GI disorders like ________–>Cl loss as HCl

Nasogastric suctioning

Loop or ___________diuretics: wasting of Cl via inhibition of the Na/K/2Cl pump and Na/Cl pump
Excessive _____________therapy

Answer 2

vomiting

thiazide

bicarbonate

Question 3

______________

Volume-independent processes

Excess mineralocorticoid activity (stimulates collecting duct hydrogen ion secretion)

Answer 3

Sodium chloride resistant metabolic alkalosis

Question 4

Whose going to do compensation for metabolic alkalosis? the lungs and its going to increase CO2 pressure because lungs does compensation the compensation from respiratory system is immediate or very fast because you go into faster breathing or slower breathing

Question 5

Sodium chloride- responsivemetabolic alkalosis (related to the volume…most likely cause is losing volume)

Treatment

Vomiting–>____________

Gastric losses of hydrogen ion during nasogastric suction –> give histamine blockers or _________

Diuretic therapy
reduce or discontinue diuretics

Answer 5

antiemetics (ondansetron)

proton pump inhibitors

Question 6

Sodium chloride responsive metabolic alkalosis

Treatment

Expand intravascular volume and replenish chloride stores
-_________ and ________-containing solutions

Volume overloaded or intolerant to volume administration

______________
carbonic anhydrase inhibitor–>inhibit renal bicarbonate reabsorption–> promote bicarbonate diuresis so your lowering bicarbonate…watch for potassium because it increase renal loss of K

Answer 6

sodium and potassium chloride containing solutions

acetazolamide

Question 7

The main cause of sodium chloride responsive metabolic alkalosis is the GI loss of chloride so you give sodium chloride infusion…if pt can’t tolerate extra sodium chloride infusion consider acetazolamide

Question 8

Sodium chloride-responsive metabolic alkalosis
Acidifying agents can be used to treat severe (pH>7.6) symptomatic metabolic alkalosis

Reserved for pts who are unresponsive to conventional fluid and electrolyte management

Unable to tolerate the requisite volume load

Treatment is _________________
must monitor ABGs

Answer 8

HCl(hydrochloric acid)

Question 9

If its sodium chloride responsive we assess intravascular volume and chloride stores if you have decreased volume you give normal saline
if pt can’t tolerate normal saline give pt acetazolamide

If its severe alkalosis consider Hydrochloric acid (HCl)

Question 10

Sodium chloride resistant metabolic alkalosis…alkalosis not really related to the volume or GI loss of the chloride…its because of mineralocorticoid excess

What can make you have mineralocorticoid excess? If pt takes a corticosteroid…so you must reduce _______or switch to a corticosteroid with less mineralocorticoid activity (prednisone, methylprednisolone, and hydrocortisone)

Answer 10

reduce dose or switch to a corticosteroid with less mineralocorticoid activity (prednisone, methylprednisone, hydrocortisone

Question 11

Sodium chloride resistant metabolic alkalosis

Patients with an endogenous source of excess mineralocorticoid (due to a disease state of excess mineralocorticoid

____________-antagonist of the mineralocorticoid receptor

__________or triamterene: inhibit the epithelial sodium channel in the distal convoluted tubule and collecting duct

Surgery if no response

Answer 11

Spironolactone

Amiloride

Question 12

If pt’s metabolic alkalosis is determined to be sodium chloride resistant then you need to ask yourself is the pt on steroid therapy if its yes then you decrease the dose or change to one with less mineralocorticoid activity meaning if pt is on cortisone and its causing metabolic alkalosis then you must switch patient to a lower activity level maybe prednisone or dexamethasone or methylprednisone

If pt is not on steroid therapy and it dues to other disease state causing mineralocorticoid excess then pick spironolactone, amiloride, and triamterene and these are potassium sparing diuretic so check potassium level

Question 13

Respiratory alkalosis
Alkalosis means pH is greater than 7.45

Respiratory means we are dealing with the lungs causing the alkalosis how lungs can get you into alkalosis? your hyperventilating your breathing out more of the CO2 excretion and then your lowering the pressure of the CO2

Question 14

Clinical presentation of respiratory alkalosis

seizures

deep, rapid __________

Tachycardia

Hypokalemia

Answer 14

rapid breathing

Question 15

How’s going to compensate in respiratory alkalosis? the kidney and how is the kidney going to help by regulating bicarbonate and the process takes days and there is decrease reabsorption of bicarboante

Question 16

Treatment of respiratory alkalosis

Mild cases (pH not exceeding 7.5) with few or no symptoms may not require treatment

Correction of the underlying disorder
Relief of pain
Treatment of fever or infection

Question 17

Treatment for life-threatening alkalosis pH>7.6 with complication such as seizure or arrhythmia

_________-with sedation and/or paralysis

Answer 17

mechanical ventilation