UNIT 2 - Lecture 7: Acid Base 3

Question 1

What is the most common acid base disturbance in patients in the clinic?

Answer 1

metabolid acidosis

Question 2

Tritration of organic acids causes decreased _____.

Answer 2

HCO3

Question 3

What are the 4 acids that can be involved in titrational metabolic acidosis?

Answer 3

1. Lactic acid
2. Uremic acid
3. Ketoacids
4. Exogenous acids

Question 4

Lactic acid results from _____ _____.

Answer 4

anaerobic metabolism

Question 5

What are differentials for lactic acid buildup?

Answer 5

Dehydration, exercise, hypovolemia, hypoxemia

Question 6

What is the AG when there is lactic acid buildup?

Answer 6

Elevated but still < 30

Question 7

Uremic acid results from _____.

Answer 7

uremia

Question 8

What are differentials for uremic acid buildup?

Answer 8

Acute renal failure, chronic renal failure

Can also be an animal that is dehydrated with pre-renal azotemia

Question 9

What is the AG when there is lactic acid buildup?

Answer 9

<30;

There are also elevations in BUN and creatinine

Question 10

Ketoacids results from _____ _____ _____.

Answer 10

negative energy balance

Question 11

What is ketoacidosis the end point for?

Answer 11

Beta-oxidation of fatty acids

Question 12

What 3 fatty acids are oxidated by ketoacids?

Answer 12

1. Beta hydroxybutyrate
2. Acetoacetate
3. Acetone

Question 13

What are the differentials for ketoacid buildup?

Answer 13

Starvation, diabetes mellitus/diabetic ketoacidosis, periparturient demands, ruminant ketosis

Question 14

What is the AG associated with ketoacid buildup?

Answer 14

>30 (usually very high ~45-50)

Question 15

How can ketoacid buildup be confirmed?

Answer 15

Ketones on dipstick, or use ketometer (for beta hydroxybutyrate)

Question 16

What is a common exogenous acid that causes titrational metabolic acidosis?

Answer 16

Ethylene glycol

Question 17

What is ethylene glycol metabolized to?

Answer 17

glycolic acid and oxalic acid

Question 18

What is the AG associated with exogenous acid/ethylene glycol metabolism?

Answer 18

>30 (often 60-70!!!!!!!)

Question 19

What is significant about ethylene glycol and urine?

Answer 19

Can hold a Wood’s lamp to urine (or up to patient’s face) to detect – will glow

Question 20

What is the first question you should ask the owner if you suspect secretional metabolic acidosis?

Answer 20

Does the pet have diarrhea?

Question 21

What is the most common cause of secretional metabolic acidosis?

Answer 21

Large bowel diarrhea;

Mucus is rich is HCO3, can cause acute or chronic loss

(EX: parvo, IBD)

Question 22

What occurs in intestinal intraluminal sequestration during secretional metabolic acidosis?

Answer 22

HCO3 rich mucous is entrapped in the “3rd space” and cannot be reabsorbed

Question 23

What are 4 methods by which animals can acquire secretional metabolic acidosis?

Answer 23

1. Diarrhea
2. Intestinal intraluminal sequestration
3. Saliva loss
4. Unique renal disorders

Question 24

What is the only animal that has secretional metabolic acidosis due to saliva loss?

Answer 24

ruminants - their saliva is rich in HCO3

Question 25

What are the 2 unique renal disorders that are related to secretional metabolic acidosis?

Answer 25

Faconi's Syndrome, Renal Tubular Acidosis

Question 26

What is renal tubular acidosis?

Answer 26

Renal tubular transport deficiencies prevent renal reabsorption of HCO3

Question 27

Are Fanconi's Syndrome and renal tubular acidosis common?

Answer 27

No - are often genetic

Question 28

What % of patients have metabolic alkalosis?

Answer 28

~10%

Question 29

What is the most common cause of metabolic alkalosis?

Answer 29

Loss or sequestration of upper GI fluid

Question 30

\_\_\_\_\_ metabolic alkalosis is specific to certain anatomical conditions.

Answer 30

Hypochloremic

Question 31

What anatomical condition causes hypochloremic metabolic alkalosis in dogs and cats?

Answer 31

Pyloric or duodenal FB

Question 32

What anatomical condition causes hypochloremic metabolic alkalosis in horses?

Answer 32

Strangulating lipoma, proximal enteritis

Question 33

What anatomical condition causes hypochloremic metabolic alkalosis in cattle?

Answer 33

Displaced abomasum (Pinching on both ends when abomasum is off to one side --\> buildup of fluid in the abomasum --\> cannot move to duodenum)

Question 34

What are the normal metabolic conditions in the GIT that allows neutralization of HCO3?

Answer 34

HCO3 is reabsorbed from the stomach while Cl^- and H⁺ are brought in --\> HCO3 brought back into duodenum from the outside --\> HCO3 joins with H⁺ that comes from stomach --\> neutralizes to H₂O + CO₂

Question 35

What is the metabolic condition in the GIT when there is metabolic alkalosis due to pyloric/duodenal obstruction?

Answer 35

HCO3 exits the stomach through serosa but H⁺ and Cl^- cannot exit to the duodenum due to obstruction --\> HCO3 builds up in blood --\> **excess HCO3** and **decreased** H⁺ and **Cl^-** = alkalinization --\> hypochloremic metabolic alkalosis (Basically H⁺ and Cl^- are entrapped in the stomach and HCO₃^- builds up bc it can't be neutralized)

Question 36

What does hypochloremic metabolic acidosis lead to?

Answer 36

paradoxical aciduria

Question 37

What are 3 requirements for paradoxical aciduria?

Answer 37

1. Dehydration 2. Low Cl^- 3. Low K⁺

Question 38

What is the normal metabolism of the kidney/nephron in response to dehydration?

Answer 38

Activation of RAS system: 1. Ultrafiltrate comes thru kidney, reabsorbs 2 Na⁺ and water 2. Also reabsorbs Cl^- to maintain electroneutrality 3. Kicks out K⁺ into urine

Question 39

How does the renal metabolism respond to dehydration in an animal with hypochloremic metabolic alkalosis?

Answer 39

1. 2 Na⁺ are reabsorbed like in normal metabolism 2. Hypochloremia = can't reabsorb Cl-, so reabsorbs excess HCO3 instead to maintain electroneutrality 3. Sequestered K+ = can't kick out K+ into urine, so kicks out H+ instead as a positive charge --\> **acidic urine = _paradoxical aciduria_**

Question 40

What is the most common cause of respiratory acidosis?

Answer 40

Intrathoracic disease (99%) - other 1% = neuro

Question 41

What are some intrathoracic diseases that can cause respiratory acidosis?

Answer 41

1. Pleural effusions 2. Pneumothorax 3. Intrapulmonary disease (pneumonia, fibrosis, CHF, pulm edema) 4. Lateral recumbency

Question 42

How can penumothorax cause respiratory acidosis?

Answer 42

Free air in chest --\> lose negative pressure system for expanding the lungs

Question 43

How can lateral recumbency lead to respiratory acidosis?

Answer 43

Lungs only fill to ~20% of normal

Question 44

What are 4 neurologic diseases that can cause respiratory acidosis? How do they do this?

Answer 44

They suppress respiratory center: 1. CNS trauma 2. Brain tumors 3. Inflammatory encephalopathies 4. Hepatic encephalopathy

Question 45

How can hepatic encephalopathy lead to respiratory acidosis?

Answer 45

Occurs when ammonia reaches very high levels i.e. in animals with portosystemic shunts or severe liver damage

Question 46

Respiratory alkalosis is caused by \_\_\_\_\_.

Answer 46

hyperventilation

Question 47

Hyperventilation is typically due to _____ or \_\_\_\_\_.

Answer 47

fear, pain

Question 48

Respiratory alkalosis is rarely associated with _____ \_\_\_\_\_.

Answer 48

neurological disorders