Acute Renal Failure + Metabolic Acidosis

Question 1

What conditions cause and worsen metabolic acidosis?

Answer 1

Acute renal failure

Sepsis

Question 2

How does ineffective antibiotic use and IV fluids lead to renal failure?

Answer 2

Antibiotics have not been effective - thus sepsis continues with vasodilation leading to renal hypoperfusion (renal failure)
IV fluid resuscitation has not been aggressive enough, leading to renal hypoperfusion
- can be a combination of the two

Question 3

What are the signs that a patient’s renal function is declining?

Answer 3

Raised creatinine

Low urine output

Question 4

What is “deep and laboured” breathing called in the context of renal failure?

Answer 4

Kussmaul breathing

• deep and laboured type of breathing which is a natural response to acidosis
• it aims to reduce the amount of CO2 in the blood and bring the pH back up (compensation)

Question 5

What ABG description would be seen in acute renal failure + Kussmaul breathing?

Answer 5

Metabolic acidosis with partial respiratory compensation
pH 7.22
pO2 18
pCO2 2.3
HCO3- 10
- acidotic (pH <7.35)
- partial respiratory compensation (partial as pH still acidotic) shown by low pCO2

Question 6

What does this ABG reading show?
pH 7.22
pO2 8
pCO2 8.3
HCO3- 24

Answer 6

Respiratory acidosis with no metabolic compensation

Question 7

What does this ABG reading show?
pH 7.22
pO2 18
pCO2 8.3
HCO3- 10

Answer 7

Mixed respiratory and metabolic acidosis

- high O2 may be oxygen therapy

Question 8

What does this ABG reading show?
pH 7.40
pO2 8
pCO2 8.3
HCO3- 38

Answer 8

CO2 retention with full metabolic compensation

- may be an ABG of a COPD patient

Question 9

What does this ABG reading show?
pH 7.51
pO2 18
pCO2 2.3
HCO3- 24

Answer 9

Respiratory alkalosis with no metabolic compensation

- panic attack with hyperventilation (with no bodily disturbance in history)