Acid Base Disorders

Question 1

Causes of increased anion gap

Answer 1

• Ketoacidosis (starvation, diabetes, ETOH)
• Uremia
• Salicylate (aspirin)
• Methanol
• Acetaminophen
• Lactate (any form of shock, INH toxicity, or iron overload)
• Ethylene Glycol
• Paraldehyde or Propylene glycol

Question 2

Delta AG to Delta Bicarb ratio and indications on source of acidosis

Answer 2

• ratio 1.6 or more = Lactate (poorly excreted)
• ratio 1:1 = ketoacids
• ratio < 1:1 = d lactate, mixed disease, or toluene toxicity

Question 3

Osmolarity formula

Answer 3

(2*Na) + (Glu/18) + (BUN/2.8)

Question 4

Normal Anion Gap Metabolic Acidosis causes

Answer 4

• Hyperchloremia
• Acetazolamide or addison’s
• RTA
• Diarrhea, ileostomy, or fistula
• Ureteroenterostomies
• Pancreatoenterostomies

Question 5

Metabolic Alkalosis causes

Answer 5

• GI acid loss
  
  • Vomiting or NG suction
• Renal acid loss
  
  • Excess mineralocorticoid
  • Licorice ingestion, liddle syndrome
  • Loop or thiazide diuretics
  • Bartter’s or Gitelman’s
  • Posthypercapnea
  • Hypercalcemia, milk-alkali
• Intercellular shifts
  
  • Laxative abuse
• Contraction alkalosis

Question 6

Acute respiratory acidosis compensation formula

Answer 6

HCO3 = 24 + [(PCO2 - 40)/10]

Question 7

Chronic respiratory acidosis compensation formula

Answer 7

HCO3 = 24 + 4( (PCO2-40) / 10 )

Question 8

Acute respiratory alkalosis compensation formula

Answer 8

HCO3 = 24 - 2( (PCO2-40) / 10)

Question 9

Chronic respiratory alkalosis compensation formula

Answer 9

HCO3 = 24 - 5( (PCO2-40) / 10) +/- 2

Question 10

Classic triad of salicylate toxicity

Answer 10

Respiratory alkalosis with metabolic acidosis and ringing in ears