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GERR > Lecture 46: Acid Base Pathophysiology > Flashcards

Lecture 46: Acid Base Pathophysiology Flashcards

1
Q

what is the biggest source of acid in the body and how is it excreted

A
  • carbonic acid from cell resp

- excreted by lungs

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2
Q

what is another source of acid in body and how is it excreted

A
  • non-carbonic in volatile acid from cell metabolism

- excreted by kidneys

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3
Q

what is the pH buffer equation

A

CO2 + H20 H2CO3 H+ + HCO3-

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4
Q

outline how asthma an cause acute respiratory alkalosis

A
  • acute asthma
  • irregular bronchoconstriction
  • ventilation/perfusion mismatch –> hypoxia and hypocapnia
  • acute resp alkalosis
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5
Q

how is acute resp alkalosis as a result of asthma treated

A

use bronchodilators

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6
Q

outline how asthma can cause acute respiratory acidosis

A
  • asthma deterioration
  • fatigue
  • -> hypoventilation
  • -> hypoxia and normocapnia
  • -> hypercapnia
  • acute resp acidosis
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7
Q

hos is acute resp acidosis as a result of asthma treated

A

assisted ventilation

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8
Q

outline how hyperventilation can cause acute resp alkalosis and chronic resp alkalosis

A
  • anxiety –> ^ ventilation
  • -> hypocapnia, ^ resp exchange ratio, tetany
  • acute resp alkalosis
  • chronic
  • -> hypocapnia, normalisation of resp exchange ratio, renal compensation
  • chronic resp alkalosis
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9
Q

how would you treat/reverse acute resp alkalosis and chronic resp alkalosis as a result of hyperventilation

A
  • reassure Px and explain
  • treat cause 2nd to other disease
  • treat underlying disease
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10
Q

outline how COPD causes chronic resp acidosis

A
  • normal ventilation –> impaired ventilation and ventilation perfusion mismatch
  • hypoxia and hypercapnia
  • chronic resp acidosis
  • exacerbations –> further hypoventilation
  • more hypercapnia
  • acute on chronic resp acidosis
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11
Q

list the causes of resp alkalosis

A
  • hyperventilation
  • -> acute
  • -> chronic
  • -> anxiety
  • -> 2nd to other systemic disease
  • hypoxia
  • -> altitude
  • -> ventilation perfusion mismatch
  • -> asthma
  • -> pulmonary vascular disease
  • liver disease
  • heart failure
  • intake of resp stimulants
  • -> aspirin
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12
Q

list causes of resp acidosis

A
  • hypoventilation
  • -> acute:
    • resp centre
    • resp muscles
    • asthma
    • airway obstruction
  • -> chronic:
    • COPD
    • restriction
  • intake of resp depressants
  • -> morphine, barbiturates
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13
Q

list causes of metabolic alkalosis

A
  • gastric secretion loss
  • -> vomiting
  • -> nasogastric suction
  • hyperaldosteronism
  • hypovolaemia
  • post hypercapnia
  • alkali ingestion
  • -> antacids
  • -> bicarbonate
  • -> citrate e.g. blood transfusions
  • diuretics
  • -> inhibition of lumen negativity
  • -> aldosterone response
  • sweat loss in cystic fibrosis
  • hypokalaemia –> movement of H+ into cells
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14
Q

list the causes of metabolic acidosis

A

normal anion gap:

  • renal tubular acidosis
  • chronic renal disease occasionally
  • diarrhoea
  • ingestion
  • -> ammonium chloride

increased anion gap

  • chronic renal disease
  • lactic acidosis
  • ketoacidosis
  • liver disease
  • ingestion of acids
  • -> aspirin
  • -> methanol
  • -> ethylene glycol
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15
Q

how is chronic resp acidosis as a result of COPD treated

A
  • bronchodilators
  • inhaled steroids
  • controlled O2 therapy
  • assisted ventilation
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16
Q

outline how COPD can cause metabolic alkalosis

A
  • too high FIO2
  • more hypercapnia
  • assisted ventilation
  • normocapnia
  • post hypercapnic metabolic alkalosis
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17
Q

outline how CKD can result in metabolic acidosis

A
  • failure to excrete non-carbonic acids and failure to reabsorb bicarbonate
  • high anion gap metabolic acidosis
  • failure to excrete K
  • hyperkalaemia
  • H+ displaced from cells
  • further metabolic acidosis
18
Q

how is metabolic acidosis as a result of CKD treated

A
  • give bicarbonate
  • treat cause of kidney disease
  • alter diet
  • fluid balance
  • dialysis
  • transplant
19
Q

outline how type 1 renal tubular acidosis can result in metabolic acidosis

A
  • failure to secrete H+ (distal tubular)
  • normal anion gap metabolic acidosis
  • failure to secrete and excrete K+
  • hyperkalaemia
  • further metabolic acidosis
20
Q

how is metabolic acidosis as a result of type 1 renal tubular acidosis treated

A

give bicarbonate

21
Q

outline how type 2 renal tubular acidosis can result in metabolic acidosis

A
  • failure to reabsorb bicarbonate (proximal tubular)

- normal anion gap metabolic acidosis

22
Q

how is metabolic acidosis as a result of type 2 renal acidosis

A

give bicarbonate (requires large doses)

23
Q

what can occur in a Px w/ type 1 and treated type 2 renal tubular acidosis

A

unusual combination of acidosis and hypokalaemia

24
Q

outline how diarrhoea can result in metabolic acidosis

A
  • loss of fluids and bicarbonate
  • normal anion gap metabolic acidosis
  • loss of K+
  • unusual combination of acidosis w/ hypokalaemia
25
Q

how can metabolic acidosis as a result of diarrhoea be treated

A

give fluids and electrolytes

26
Q

outline how vomiting can result in metabolic alkalosis

A
  • loss of gastric acid
  • metabolic alkalosis
  • loss of K+
  • hypokalaemia
  • further alkalosis
  • loss of fluids
  • hypovolaemia
  • hyperaldosteronism
  • further metabolic alkalosis
  • inability of kidneys to excrete bicarbonate
  • prolongation of alkalosis
27
Q

outline how hyperaldosteronism can result in metabolic alkalosis

A
  • hyperaldosteronism
  • ^ H+ secretion
  • metabolic alkalosis
  • ^ K+ secretion
  • hypokalaemia
28
Q

how might metabolic alkalosis as a result of hyperaldosteronism be resolved

A

adrenalectomy

29
Q

outline how hypoaldosteronism can result in metabolic acidosis

A
  • hypoaldosteronism
  • reduced H+ secretion
  • normal anion gap metabolic acidosis
30
Q

how might metabolic acidosis as a result of hypoaldosteronism be resolved

A

give aldosterone

31
Q

outline how diabetic ketoacidosis can result in metabolic acidosis

A
  • low cell glucose
  • shift to fat metabolism
  • mitochondria overwhelmed
  • acetone, acetoacetate and B-hydroxybutarate
  • high anion gap metabolic acidosis
  • K+ from cells
  • loss in diuresis
  • hyperkalaemia
32
Q

how can metabolic acidosis as a result of diabetic ketoacidosis be treated

A
  • insulin
  • fluids
  • bicarbonate
  • electrolytes
33
Q

outline how hepatocellular dysfunction can cause resp alkalosis and metabolic alkalosis

A
  • abnormal levels of toxins and hormones stimulate resp centre
  • chronic resp alkalosis
  • hypoalbunimaemia
  • further metabolic alkalosis
34
Q

outline how hepatocellular dysfunction can result in metabolic acidosis

A
  • abnormal amino acids and other acids

- metabolic acidosis

35
Q

how might metabolic acidosis as a result of hepatocellular dysfunction be resolved

A
  • treat underlying cause e.g. alcohol abuse

- liver transplant

36
Q

outline how salicylate ingestion can result in metabolic acidosis

A
  • non carbonic acid

- high anion gap metabolic acidosis

37
Q

outline how salicylate ingestion can result in resp alkalosis

A
  • stimulation of ventilation
  • additional hyperventilation
  • resp alkalosis
38
Q

how might resp alkalosis as a result of salicylate ingestion be resolved

A

forced alkaline diuresis

39
Q

outline how IV saline pH 7.0 can result in metabolic acidosis

A
  • dilution of bicarbonate
  • hyperchloraemia
  • metabolic acidosis
40
Q

how might metabolic acidosis as a result of IV saline pH 7.0 be resolved

A

citrate based infusions

GERR (46 decks)

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