11-12 Flashcards
(36 cards)
Metabolic acidosis is pH< ____
Reduced ____
____ compensation by ___
7.36
HCO3
Respiratory, by hyperventilating resulting in reduced PCO2
In metabolic acidosis, an anion gap develops when the accumulating acid contains ___
An anion other than Cl
The most common cause of increased anion gap is ____.
What is a normal anion gap?
Metabolic acidosis
12
Most of the unmeasured anion is ___.
Albumin (normal anion gap is 3x the albumin)
Anion gap calculation:
Na-(Cl+HCO3)
Causes of anion gap acidosis:
L-Lactic acidosis Uremia D-Lactic acidosis Alcoholic and diabetic ketoacidosis Toluene Ethylene glycol and methanol
If the anion gap is >30, the most common anions are ____
Lactate (lactic acidosis) and B-hydroxybutyrate and acetoacetate (ketoacidosis) of
Metformin can cause ___
Type B/D-Lactic acidosis
How do you distinguish between extrarenal and renal causes of metabolic acidosis?
Urinary anion gap = U.Na + U.K - U.Cl
Normally 30-50
-negative value suggests increased renal excretion of unmeasured cation such as NH4
-positive for renal origin, NH4 excretion is minimal
-large negative is extrarenal, increased NH4
Type 1 RTA
Type 2 RTA
Type 4 RTA
- Classical distal, low plasma K, high Urine pH,
- Proximal, low plasma K, low Urine pH
- Generalized distal defect, high plasma K, low or high Urine pH
Mineral acid-induced acidosis ____ K.
Organic acid-induced acidosis ____ K.
Increases
Does not change
Metabolic alkalosis is serum bicarbonate ___
Greater than 28 (total CO2 greater than 30)
Metabolic alkalosis ___ respiration
Inhibits
*do not extubate
PCO2 increases by ____ for each 1 mmol/L increase in HCO3
0.7 mmHg
____ is due to defective Na-K-2Cl cotransporter. It presents as hypokalemic, hypochloremic metabolic alkalosis
Bartters syndrome
____ is due to defected channels and is characterized by severe hypomagnesemia and hypocalcemia and predominantly neuromuscular symptoms such as cramping or tetany
Gitelmans syndrome
____ is due to increased activity of a collecting duct Na channel, and presents as HTN due to volume expansion, hypokalemic acidosis, and normal aldosterone levels
Liddles syndrome
Chloride resistant alkalosis Treatment for 1. Liddles syndrome 2. Bartters syndrome 3. Gitelmans syndrome
- Amiloride
- NSAIDs
- NSAIDs and Ca and Mg replacement
USPSTF recommendations:
Grade A
Strongly recommended
Good evidence that benefits substantially outweigh harms
USPSTF recommendations:
Grade B
Recommended
Fair evidence that benefits outweigh harms
USPSTF recommendations:
Grade C
No recommendation for or against
Fair evidence, but balance of benefits and harms is too close
USPSTF recommendations:
Grade D
Recommends against routinely providing
Fair evidence that it is ineffective or harms outweigh benefits
USPSTF recommendations:
Grade I
Insufficient evidence
Three criteria are important when deciding what conditions to screen for:
- Burden of suffering (consider prevalence and severity)
- Effectiveness, safety, and cost
- Performance of test
