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CPR Final > Clin Med approach to Acid Base Disorders > Flashcards

Clin Med approach to Acid Base Disorders Flashcards

(59 cards)

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1
Q

Low serum HCO3- corresponds with what?

A

Metabolic acidosis

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2
Q

High serum HCO3- corresponded with what?

A

Metabolic alkalosis

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3
Q

High PCO2 corresponds with what?

A

Respiratory acidosis

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4
Q

Low PCO2 corresponds with what?

A

Respiratory alkalosis

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5
Q

What are the two types of metabolic acidosis?

A
  1. High anion gap metabolic acidosis

2. Non anion gap metabolic acidosis (hyperchloremic acidosis)

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6
Q

What are the two types of metabolic alkalosis?

A
  1. saline responsive (hypovolemia/ contraction alkalosis)

2. Saline non responsive - euvolemia or hypervolemia

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7
Q

What is the compensation for metabolic acidosis?

A

Winter’s formula : PCO2 =1.5(HCO3-) +8 +/- 2

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8
Q

What is compensation for metabolic alkalosis?

A

PCO2 will increase by 0.7mmHg for each 1.0mEq/L increase in HCO3 from normal

(normal HCO3 is 24)

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9
Q

What is compensation for acute respiratory acidosis?

A

HCO3 will increase by 1mEq/L for every 10 mmHg increase of PCO2 from normal

normal PCO2 is 40mmHg

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10
Q

What is the compensation for Chronic respiratory acidosis?

A

chronic acidosis will show HCO3 will increase of 3.5 mEq/L for every 10 mmHg increase of PCO2 from normal of 40mmHg

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11
Q

What is the compensation for acute respiratory alkalosis?

A

HCO3 will decrease by 2mEq/L for every 10 mmHg decrease in PCO2 from normal

normal PCO2 is 40 mmHg

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12
Q

What is the compensation for chronic respiratory alkalosis?

A

HCO3- will decrease by 5 mEq/L for every 10 mmHg decrease in PCO2 from normal

normal PCO2 is 40 mmHg

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13
Q

What is normal pH of ABG?

A

pH 7.35-7.44

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14
Q

What is the normal HCO3- concentration in ABG?

A

24 mEq/L

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15
Q

What is the normal PCO2 concentration in ABG

A

40mmHg

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16
Q

What is the normal anion gap in ABG?

A

12 +/- 2

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17
Q

What is the normal osmolarity gap in ABG?

A

10mosm/kg

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18
Q

What is the anion gap formula?

A

(Na+) - (HCO3- +CL-)

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19
Q

what is normal serum osmolality?

A

275-290mosm/kg

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20
Q

What is osmolar gap?

A

measured serum osmolality -calculated serum osmolality

normal <10mosm/kg

if osmolar gap>10mosm/kg –> consider additional solutes in the blood

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21
Q

Why would an osmolar gap calculation be used clinically?

A
  1. screen for alcohol ingestion (AG>20) – esp in HAGMA
  2. Screen for ketoacidosis
  3. screen for lactic acidosis
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22
Q

What is the use of the Delta-Delta gap?

A

Delta-delta gap is used in patients with HAGMA to determine if there is a coexistent NAGMA

-every increase in AG should correspond with an equal decrease in serum HCO3

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23
Q

What is GOLD MARK?

A

DDX for HAGMA

Glycols
Oxoproline (pyroglutamic acid- acetaminophen toxicity)
L - L -lactic acidosis
D D-lactic acidosis (seen in short bowels syndrome from bacteria colonies)

Methanol
Aspirin
Renal Failures
Ketoacidosis (alcoholic, diabetic, starvation)

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24
Q

What is ME DIE

Study These Flashcards
A

DDX of increased osmolar gap— these will kill you if not fixed

M- methanol
E-Ethanol

D-Diethylene glycol
I- Isopropyl alcohol
E-ethylene glycol

Propyleny glycol, keto acidosis, and lactic acidosis also included

25
Methanol is concerted to what?
Methanol is converted to formic acid which can cause blindness (optic disk damage)
26
What is the ethylene glycol metabolism?
ethylene glycol--> glycolic acid --> glyoxylic acid--> renal failure, oxalic acid, and glycine
27
What is DURHAAM?
DDX for Normal anion gap metabolic acidosis (NAGMA) D- diarrhea **** U-uretal diversion R- renal tubular acidosis ***** H-hyperalimentation (parenteral nutrition A-acetazolamide (carbonic anhydrase inhibitor) A-addisions disease M-miscellaneous
28
What occurs when net excretion by the kidneys is impaired and results in NAGMA?
Renal tubular acidosis
29
What cannot be diagnosed in the setting of AKI?
RTA
30
Results from decreased net H+ ion section in distal tubules and collecting duct
RTA 1 (Distal RTA)
31
Results from decreased HCO - reabsorption in the proximal tubule
RTA 2 (Proximal RTA)
32
Results from decreased aldosterone secretion or aldosterone resistance
RTA 4 - Hyperkalemic RTA -leads to decreased net H+ and K+ section in the collecting duct hyperkalemia-> decreased NH3 synthesis in PCT-> decreased NH4 secretion
33
What is the most common RTA seen in DM2 or CKD?
Type 4 RTA (shows hyper kalmia and + urine anion gap
34
What has amionaciduria, phosphaturia, glycosuria, Bicarbonaturia, tubular proteinuria, uricosuria?
Proximal tubular dysfunction - Fanconi syndrome - may lead to metabolic acidosis, hypophosphateimia, osteopenia
35
What is the Urine anion gap used for?
differentiate renal from non-renal causes of NAGMA -marker of NH4CL exertion UAG = (UrineNa+ + Urine K+) – UrineCl- Mproximl • If UAG is negative, it indicates appropriate distal nephron urinary acidification • If UAG is positive, it indicates inappropriate distal nephron urinary acidification
36
What ion is produce from glutamine metabolism in proximal tubule cell?
NH4+
37
What is permeable? NH3 or NH4+?
- AmmoNIA (NH3) is highly permeable and can cross the cell membrane of tubular cells easily - AmmoNIUM (NH4+) is impermeable and needs transporter help to move in and out of tubular cells - Once a H+ ion bind to NH3 in the collecting duct forming NH4+, it is trapped within the tubular lumen and is ultimately excreted in urine
38
Why is urine Cl- the surrogate marker of ammonium excretion?
NH4+ is bound to Cl- to become NH4Cl-
39
Cystinosis in children and Fanconi syndrome in adults (secondary multiple myeloma) , and carbonic anhydrase inhibitors can cause what?
Proximal RTA - type 2 -Increased risk of hypophosphotemic rickets
40
NAGMA with or without proximal tubular dysfunction and Hypokalemia are clinical manifestations of what?
RTA 2--> Hypokalemia is Mild compared to distal RTA (type 1) RTA 2 is defect in HCO3 reabsorption in PCT causes increased HCO3 in urine and metabolic acidosis
41
Patients with this RTA cannot acidify urine
RTA 1 (distal RTA) Results from decreased net H+ ion secretion in the distal nephron: 1. Decreased H+ ion secretion • H+/K+-ATPase or H+-ATPase defect 2. Gradient defect • Abnormally permeable distal tubule and collecting duct allows secreted H+ ions to flow back into tubular cell – Can be caused by Amphotericin for fungal infections • Lack of net H+ ion secretion prevents urinary acidification and excretion of ammonium – Also prevents some HCO - reabsorption in the distal tubule 3
42
What RTA could be seen with Sjogrens or Glue sniffing (Toulene)
Distal RTA (RTA type 1)
43
What RTA is associated with nephorlithisasis or nephrocalcinosis?
Distal RTA- RTA 1 -decreaed H+ excretion from distal nephron and can't acidify urine so ammonium is not excreted
44
Acidosis is associated with?
hyperkalemia
45
alkalosis is associated with?
hypokalemia
46
1. Hypokalemia 2. Vomiting/nasogastric tube suctioning 3. Diuretics 4. volume depletion 5. mineralocorticoid excess can all cause what?
Metabolic alkalosis
47
NKCC2 mutation
Bartter syndrome type 1
48
ROMK mutation
Bartter syndrome type 2
49
CLC-Kb mutation
Bartter syndrom type 3
50
Barttin mutation
Bartter syndrome type 4
51
What is net result of Bartter Syndrome similar to?
loop diuretic
52
– Severe hypokalemia – Metabolic alkalosis (saline non-responsive) – Low to normal blood pressure – Hypercalciuria and nephrocalcinosis are clinical sx of?
Bartter Syndrome
53
– Severe hypokalemia – Metabolic alkalosis (saline non-responsive) – Low to normal blood pressure – Hypocalciuria (opposite of Bartter Syndrome, helpful distinguishing tool) • Like seen with thiazide diuretics – Hypomagnesemia are clinical symptoms of?
Gitelman Syndrome
54
Inactivating mutations in TAL transporters causes?
Bartter's syndrome (rare)
55
Inactivating mutations in Na-Cl co-transporter NCCT causes?
Gitleman sundrome
56
Net result of Gitleman syndrome is similar to?
Thiazide Diuretic use
57
Resistant Hypertension – Hypokalemia – Metabolic alkalosis (saline non-responsive) are seen in ?
Liddel Syndrome
58
Mutations in epithelial Na+ channels in the collecting duct of the nephron causes what?
Liddle syndrome
59
What is tx of liddle syndrome?
- Amiloride or triamterene

CPR Final (2 decks)

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