Acid Base Balance

Question 1

Normal Acid Base
Organs?
Leveles ?

Answer 1

• Cooperation of Lungs and Kidneys + GI
• **GI: **Acid-Base Disturbances; Backdrop for acid base disorders
• Normal Range of pH 7.35 to 7.45
• Tight Conrol Need

Question 2

Disturbances Repitory

Answer 2

CO2
Only one respitory disturbance possible

Question 3

Disturbance HCO3 (Bicarb)

Answer 3

GI /Metabolic Disturbance
More than one metabolic Disturbance co-exist
Coexisting metabolic acidosis and alkalosis (vomiting)

Question 4

Homeostasis
Dependent on compensation

Answer 4

Compendsation for RR distrurbance =>metabolic
Compensation for metabolic disturbance =>Respitory

Question 5

Metabolic Acidosis
Can lead to what

Answer 5

Acidemia

Question 6

Acidemia

Answer 6

-Result in Metabolic Acidosis
- High Hyrogen Ion concentration Or Low PH of Blood (<7.35)
- Reduction occurs due to reduction of Extracellular Bicarbonates
- Reduced by consumption of bicarb or primary loss
-

Question 7

Amoniagenesis
Aciddemia
Alkalosis

Answer 7

Stimulated by Acidemia
Inhibted by Alkalosis

Question 8

Ammoniagenesis
Hyperkalemia and Hypokalemia

Answer 8

Inhibit - Hyperkalemia
Stimulate -Hypokalemia

Question 9

Metablic Acidosis
Causes

Answer 9

• Excessive Production of Fixed Acid
• Decreased renal Secretion Fixed Acid
  *** Loss of Bicarbonate (CO 3) **

Question 10

Plasma Anion Gap

Answer 10

Normal Level : (8)
Formula: Na-(CO3+CL)
Difference of cation vs anions
Albumin : Always Proportional to Anion Gap

Question 11

Hypoalbuminemia W Anion Gap

Answer 11

Albumin always proportion Anion Gap
Falsely **Lower **Anion Gap –>

                          ****Hihgh Anion Gap Acidosis **

Question 12

Increase Albumin

Answer 12

Increase Anion Gap
Fallse impressio of High anion Gap Acidosis

Question 13

Metabolic Acidosis
**High Anion Gap Acidosis (open GaP )

Answer 13

Lactic Acidosis : Most common Reason
* Propylene Glycol
Ketoacidois
ETOH
Starvation , Intoxications, Salicylate

Question 14

Propylene Glycol ?

Answer 14

Reason for High GAP metablolic Acidosis

Solven found in Common medications result in

Ativen
Nitroglycerin
Etomidate
Phenytoin

Question 15

What Are the reason for Lacic Acidosis
W High GAP

Answer 15

• Not Always Sepsis
• Type A and Type B

Question 16

Cause of Lactic Acidosis
Type A

Answer 16

• Imbalance of tissue O2 demand and supply
• Decrease O2 delivery
• Shock, HYpoxia, Profound Anemia, Carbon Monoxide Poison
• Gran mal seizure or exreme exercise

Question 17

Lactic Acidosis
Type B Cause

Answer 17

Encapsulates other etiology
HIV, ETHO, Malignancy
Liver failure

Question 18

Metabolic Acidosis
**Non-Gapped : Causes **

Answer 18

• **Renal Tubular Acidosis **
  Post-Hypocapnic Metabolic Acidosis
  Dilutional Hyperchloremic Acidosis

Question 19

What is
Renal Tubular Acidosis

Answer 19

• HCO3 Falls &
• CL Increased
• Gap Not open
  = Non-Gap Metabolic Acidosis

Question 20

Dilutional Hyperchloremic Acidosis

Answer 20

Resucitation w Isotonic Saline
Blood HCO3 -diluted

Question 21

Post-Hypocapnic Metabolic Acidosis

Answer 21

HCO3 falls
in compensation for
Chronic RR alkalosis
Unchange GAp

Question 22

Metabolic Acidosis
Severe Acidemia
PH?

Answer 22

PH < 7.20
Cardiovasular function
Hepatic Function
Metabolic derangements

Question 23

**HCO3 LOW (below 22)
Increase Anion Gap **
**What DX? **

Answer 23

High Anion Gap metabolic Acidosis
occurs

Question 24

Low CO3 (<22)
None Gap

Answer 24

• Hypercholoremic metabolic acidosis
• Respitory alkalosis w metabolic compensation
• Lactic Acidosis (Check LA ) –> DKA, Starvation, ETOH

Question 25

Metabolic Acidosis Treatment Plan

Answer 25

* PH <7.10 * Treat underlying cause * Treat RR etiology first * Sodium Bicarb (Alkali solution ) with Goal 7.20 * HD/CRRT : metoformin induced acidosis

Question 26

Metabolic Alkalosis Overview

Answer 26

Accumulation of Bicarb PH increase (PH > 7.45) Due to Hypoventilation CO2 Retension

Question 27

Metabolic Alkalosis Two Causes ?

Answer 27

1**. Genrate Alkalosis ** A. Loss of Acid from body B. Renal source **2. Maintain or Perpetuate Alkalois** Volume Depletion Hypokalemia

Question 28

Generating Alkalosis **Loss of Acid from Body **

Answer 28

GI source Vomiting Gastric Suction

Question 29

Generating Alkalosis Renal Source

Answer 29

High NA delivery Corticoid K depletion High Renal Ammoniagenesis

Question 30

Metabolic Alkalosis Maintaining Alkalosis

Answer 30

Relative or Absolute

Question 31

Relative Metabolic Alkalosis

Answer 31

* **Volume Depletion ** * RElative * Diminished effective circulatting Volume * reduce GFR * Enhance CO3 Secondary to Hyperaldosteronis Overload secondary to Volume Overload

Question 32

Bohr Effect

Answer 32

**Increase Hgb O2 affinity ** Impaired O2 delivery to tissues

Question 32

* lactic Alkalosis

Answer 32

Low PCO2 Elevated Blood lactate level

Question 33

Perpetuating factors for Alkalosis

Answer 33

Hypokalemia Gastric losss Supress Ventilation