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Stage 2: Supporting Life > Metabolic Acidosis > Flashcards

Metabolic Acidosis Flashcards

1
Q

Between what pHs is intracellular pH maintained?

A

7.0 and 7.3

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2
Q

How does metabolic acidosis occur?

A
  • Loss of CO2 drives formation of H+ into H2O

- Therefore, you become acidotic if have a lot of H+ and can’t blow off enough CO2

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3
Q

How does respiratory acidosis?

A

If you can’t blow off enough CO2, the equation goes in the other direction, increasing H+

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4
Q

What is the primary disturbance in metabolic acidosis?

A

Decreased bicarbonate

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5
Q

What is the primary disturbance in metabolic alkalosis?

A

Increased bicarbonate

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6
Q

What is the primary disturbance in respiratory acidosis?

A

Increased pCO2

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7
Q

What is the primary disturbance in respiratory alkalosis?

A

Decreased pCO2

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8
Q

What is the compensatory response in metabolic acidosis?

A

Decreased pCO2

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9
Q

What is the compensatory response in metabolic alkalosis?

A

Increased pCO2

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10
Q

What is the compensatory response in respiratory acidosis?

A

Increased bicarbonate

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11
Q

What is the compensatory response in respiratory alkalosis?

A

Decreased bicarbonate

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12
Q

What is the definition of metabolic acidosis?

A

A low arterial blood pH in conjunction with a reduced serum bicarbonate concentration

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13
Q

Why is it important to detect metabolic acidosis?

A
  • Acidic environment associated with lots of significant medical conditions
  • Metabolic acidosis → increased mortality
  • Easy identified and potentially correctable
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14
Q

What is metabolic acidosis not?

A

A diagnosis → it is a sign of something else you need to diagnose

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15
Q

What is the anion gap due to?

A

Not measuring many anions (many proteins) → measure fewer anions than cations, causing an anion gap (even though we know it is equal

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16
Q

What are the measured cations?

A

Na+ and K+

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17
Q

What are the measured anions?

A

HCO3- and Cl-

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18
Q

What does an increased anion gap indicate?

A

An increase in the concentration of anions other than chloride or bicarbonate

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19
Q

What is the equation showing that plasma is always electroneutral?

A

Measured cations + unmeasured cations = measured anions + unmeasured anions

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20
Q

Why does low bicarbonate mean an increased anion gap?

A

Bc there is a higher concentration of an unmeasured anion

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21
Q

What happens during normal anion gap acidosis?

A
  • Have lost bicarbonate but chloride has compensated

- Bicarbonate loss but chloride reabsorption

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22
Q

What are causes of normal anion gap acidosis?

A

1) GI losses of bicarbonate → diarrhoea, surgical drains/fistulae
2) Renal losses of bicarbonate → renal tubular acidosis

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23
Q

What is the mnemonic to remember for increase anion gap acidosis?

A

GOLDMARK

24
Q

What are causes of increased anion gap acidosis?

A

1) Glycols (ethylene, propylene) - antifreeze
2) Oxyproline
3) L-lactate (common when sick)
4) D-lactate (common when sick)
5) Methanol
6) Aspirin
7) Renal failure
8) Ketoacidosis

25
Q

What is lactic acidosis?

A

The result of lactic production in anaerobic respiration

26
Q

When does lactic acidosis happen?

A

In any form of shock

27
Q

What is ketoacidosis?

A

The result of ketone production from fat metabolism when cells can’t take up glucose

28
Q

What are ketones?

A

Unmeasured anions

29
Q

What are the main causes of ketoacidosis?

A

Diabetes, alcohol and starvation

30
Q

What are the most common causes if increased anion gap?

A

Lactic acidosis and ketoacidosis

31
Q

Describe taking ABGs

A
  • Commonly use radial artery or femoral artery
  • Can be painful
  • Low resistance
  • Don’t need vacuum
  • BP pushes plunger up and fills up syringe on its own
32
Q

What is the desired range of pCO2?

A

4.5-6.0 kPa

33
Q

What is the desired range of pO2?

A

10-13 kPa

34
Q

What is the desired range of HCO3-?

A

24-26 mmol/L

35
Q

What is the desired range of SpO2 (on ABG)?

A

96-100% (more accurate than finger probe)

36
Q

What is the desired range of base excess?

A

+2 → -2

37
Q

What does a low base excess (-3 or lower) indicate?

A

(Metabolic) acidosis

38
Q

What does a high base excess indicate?

A

Alkalosis

39
Q

What is the base deficit?

A

Same as base excess but opposite numbers

40
Q

What H+ concentration is alkalosis?

A

H+ < 35 nmol

41
Q

What H+ concentration is acidosis?

A

H+ > 45 nmol/L

42
Q

What PaCO2 level indicates respiratory acidosis or respiratory compensation for a metabolic acidosis?

A

> 6.0 kPa/45 mmHg

43
Q

What PaCO2 level indicates respiratory alkalosis or respiratory compensation for a metabolic acidosis?

A

< 4.7 kPa/35 mmHg

44
Q

What HCO3- level indicates metabolic acidosis or renal compensation for a respiratory alkalosis?

A

< 22mmol/L

45
Q

What HCO3- level indicates metabolic alkalosis or renal compensation for a respiratory acidosis?

A

> 26 mmol/L

46
Q

When is acidosis/alkalosis truly compensated?

A

When you have normal pH

47
Q

When is acidosis partially compensated?

A

When pH is higher than expected but still not normal

48
Q

What do you need for respiratory compensation?

A

Capacity of lungs

49
Q

In what case could you have mixed metabolic and respiratory acidosis?

A

In someone with COPD and CKD → pt might not be able to compensate for acute respiratory/metabolic acidosis

50
Q

What does not happen with regard to compensation?

A

Over compensation

51
Q

What is the normal anion gap range?

A

8-12 mmol/L

52
Q

Which test is most important to do if you suspect diabetic ketoacidosis and why?

A

Urinalysis → bc can see ketones and glucose (compared to blood glucose)

53
Q

Generally what should pO2 be?

A

10 less than the % you are breathing → so at sea level, 21% (11kPa)

54
Q

Why do GI losses lead to metabolic acidosis with a normal anion gap and high chloride?

A

1) Chloride reabsorbed balances bicarbonate lost

2) No generation of extra acid e.g. lactate or ketones

55
Q

Why does increased anion gap occur?

A

Production of acids which are also anions

Stage 2: Supporting Life (30 decks)

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