Acid-Base

Question 0

A(n) _______ is a substance that ACCEPTS a proton.

Answer 0

base

Question 1

A(n) _______ is a substance that can DONATE a proton.

Answer 1

Acid

Question 2

Causes of metabolic acidosis:

Answer 2

1. increased serum anion gap 
     • lactic acidosis
     • diabetic ketoacidosis
     • renal failure (acute or chronic)
     • methanol ingestion
     • ethylene glycol ingestion (antifreeze)
     • salicylate overdose (ASA)
     • starvation
2. Normal serum anion gap with hyperchloremic states 
     • GI or bicarb loss
     • drugs
     • renal tubular acidosis

Question 3

With metabolic acidosis we expect:

Answer 3

low pH (<7.35)
low bicarb levels
respiratory rate/volume to increase

Question 4

What drug can cause lactic acidosis?

Answer 4

METFORMIN

Question 5

What is the anion gap equation?

Answer 5

Anion gap = (Na+) - (Cl- + HCO3-)

Question 6

What is the normal range for the anion gap?

Answer 6

10-14

Question 7

What is the difference of total unmeasured anions and cations?

Answer 7

The Anion Gap

Question 8

What does the anion gap tell us?

Answer 8

What type of metabolic acid we have and what the potential cause may be

Question 9

What is the first thing you do once you know your patient has metabolic acidosis?

Answer 9

calculate the anion gap

Question 10

How do you treat metabolic acidosis caused by methanol/ethylene glycol?

Answer 10

Ethanol
Fomepizole IV (EXPENSIVE)
Continue until methanol < 20 mg/dL

Question 11

What are the ADRs of Ethanol or Fomepizole IV to treat methanol/ethylene glycol ingestion?

Answer 11

headache
nausea
dizziness
agitation
metallic taste
abnormal smell
rash

Question 12

How do you treat DKA that causes metabolic acidosis?

Answer 12

dextrose, insulin protocol

Question 13

What does DKA stand for?

Answer 13

Diabetic ketoacidosis

Question 14

How do you treat metabolic acidosis caused by renal failure?

Answer 14

Dialysis

Question 15

How do you treat metabolic acidosis caused by lactic acidosis?

Answer 15

• remove the offending agent causing the lactic acidosis (ex. metformin)
• alkalinizing therapy
• K+ replacement prn

Question 16

How do you treat metabolic acidosis caused by starvation?

Answer 16

fluids

monitor electrolytes for re-feeding syndrome

Question 17

How do you treat metabolic acidosis caused by salicylate overdose?

Answer 17

• gastric lavage
• activated charcoal
• hemodialysis
• fluids

Question 18

What is the first goal of treatment for acute severe metabolic acidosis?

Answer 18

raise pH > 7.2 and HCO3- > 8 mEq/L

Question 19

How is acute severe metabolic acidosis classified?

Answer 19

pH < 7.2

HCO3- < 8 mEq/L

Question 20

Which of the following is sodium bicarb compatible?
A. D5W
B. NS

Answer 20

both A and B