Acid and Bases

Question 1

What is the winter’s equation?

Answer 1

Is to prove that in a primary metabolic acidosis there was a respiratory compensation

Question 2

what is unique about the hyperchloremic metabolic acidosis?

Answer 2

there is a decrease in bicarbonate resulting in primary metabolic acidosis but no increase in the anion gap

Question 3

what are the causes of non-anion gap metabolic acidosis?

Answer 3

• diarrhea
• renal tubular acidosis
• carbonic anhydrates inhibitors
• uretero sigmoidostomy(where more chloride will be absorbed than bicarbonate leading to a non-gap metabolic acidosis)
• Anything that contributes to excessive chloride in the body (acidifying salts like ammonium chloride/normal saline)

Question 4

what is the significance of albumin when dealing with high anion gap metabolic acidosis?

Answer 4

if the albumin is low, then you have to take that into consideration when calculating the anion gap. for each gram of albumin that is depressed you must add 2.5 milliequivalents

Question 5

what is the mnemonic for high anion gap metabolic acidosis

Answer 5

-GOLDMARK

Question 6

GOLDMARK

Answer 6

• Glycols(diethylene glycol, ethelyne glycol, propylene glycol(preservative in IV lines))
• 5-oxoproline (metabolite of Tylenol)
• Lactate
• Methanol
• Aspirin
• Renal failure
• Ketoacidosis

Question 7

What two conditions are associated with high lactate levels?

Answer 7

Ischemic bowel disease or sepsis is associated with high L-lactate levels. Short bowel due surgery, they hae overgrowth of certain bacteria which form D-lactic acid. Both L-lactate and D-lactate can cause high anion gap metabolic acidosis

Question 8

what is the delta ratio

Answer 8

it is the formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether a mixer acid base disorder

Question 9

what does a delta ratio of 1

Answer 9

most of the time the increase in the anion gap and the decrease in bicarbonate is equivalent in pure high anion gap metabolic giving you a delta ratio of 1

Question 10

if the delta ratio is more than 2 or less than 1

Answer 10

you have a co-existing non-gap acidosis (diarrhea) in addition to the high anion gap acidosis

Question 11

when will the patient present with mixed acid base disturbance

Answer 11

• if compensation does not exist in a patient, they have a mixed disturbance
• if compensation exceeds the proposed limits, it’s a mixed acid base disturbance

Question 12

primary respiratory alkalosis has what on its differential diagnose

Answer 12

• cardiopulmonary (which causes you to hyperventilate to improve oxygenation causes you to also expel CO2)
• Intra-cranial pathology (decompensated brain tumor, meningitis, encephalitis) (respiratory centers leading to hyperventilation)
• Drugs (salicylate, xanthines such as theophylline)
• sepsis
• liver failure
• pregnancy
• hysteria

Question 13

what kind of intoxication does aspirin cause

Answer 13

mixed acid-base disturbance. first from the metabolic acidosis and inappropriate respiratory alkalosis compensation.

• causes mixed acid-base in adults but it is more of a respiratory alkalosis and some metabolic acidosis and respiratory component is more pronounced
• pH is normal

Question 14

Xanthines cause what kind of intoxication

Answer 14

respiratory alkalosis. it is commonly used in the past to treat asthma

Question 15

how does sepsis cause respiratory alkalosis

Answer 15

• sepsis can cause respiratory alkalosis due to alterations of the microcirculation
• the CNS causes you to hyperventilate during sepsis resulting in respiratory alkalosis
• a high WBC count and or fever is also seen with sepsis

Question 16

What does pregnancy cause

Answer 16

it is associated with respiratory alkalosis. A physiological response to normal pregnancy is a respiratory alkalosis for unknown reasons. The compensation to defend the pH in any respiratory alkalosis is for the kidney to lose bicarbonate. The low bicarbonate in the pregnant woman thus represents appropriate compensation for a respiratory alkalosis which is normal in pregnancy

Question 17

Hysteria can also cause what and what is the mechanism

Answer 17

vii. Hysteria can also cause acute respiratory alkalosis. Hysteria causes cramps and paresthesias. Calcium exists in the blood bound to albumin as well as freely. This is an equilibrium relationship. Only free calcium is pharmacologically active. Albumin-bound calcium is not pharmacologically active. The equilibrium between free calcium and bound calcium is pH dependent.
1. In respiratory alkalosis, you have hypocalcemia because the equilibrium shifts so that you have more bound calcium. Hysteria-induced respiratory alkalosis thus results in tetany. Tetany is dangerous because it can cause laryngospasm.
2. Tetany can be tested for by checking for carpopedal spasms. To elicit carpopedal spasms (i.e. Trousseau’s sign) in a person with hysteria-induced respiratory alkalosis, a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient’s hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forear

Question 18

Respiratory acid base disturbances unlike metabolic can be

Answer 18

acute or chronic

Question 19

what is post hypercapnic metabolic alkalosis

Answer 19

when a patient’s PCO2 was lowered too quickly due to intubation resulting in the seizure

Question 20

what drugs can give a patient hypokalemic acidosis according to this lecture

Answer 20

low potassium can cause metabolic acidosis and it is due to loop diuretics like furosemide as well as diarrhea