Mixed Acid Base

Question 1

What is a mixed acid base disorder?

Answer 1

characterized by the presence of two or more separate primary acid-base abnormalities occurring in the same patient

Question 2

How long may respiratory compensation to a metabolic alkalosis take to be complete in the dog?

Answer 2

17-24hrs

Question 3

. Discuss the two phases of compensation to a respiratory acidosis

Answer 3

first phase represents titration of nonbicarbonate buffers, whereas in respiratory alkalosis, the first phase represents release of H from nonbicarbonate buffers within cells.
- Complete in 15 minutes
The second phase reflects renal adaptation and consists of increased net acid excretion and increased HCO3 _ reabsorption (decreased Cl _ reabsorption) in respiratory acidosis and a decrease in net acid excretion in respiratory alkalosis.

Question 4

Do cats compensate for metabolic or resp disorders?

Answer 4

They appear to compensate for resp disorders – maybe. Can increase HCO3 in response to an increase in CO2

Question 5

What is dibart’s clinical approach to acid base disorders

Answer 5

History, clinical exam, Chem + UA, blood gas  primary disorder  calc expected compensation – if not within 2mmHg or mEq/L then likely mixed disorder.

Question 6

What effect does increases or decrease in chloride cause?

Answer 6

Increases in chloride lead to metabolic acidosis
by decreasing SID, whereas decreases in chloride cause
metabolic alkalosis by increasing SID

Plasma chloride and bicarb tend to change in opposite directions

Question 7

How may the chloride gap be calculated?

Answer 7

cl- gap = cl (normal) - Cl (corrected)
cl gap = cl (normal) - cl (patient) x na (normal)/na (patient)

Question 8

What do chloride gap values mean

Answer 8

Values greater than 4 mEq/L are associated with
hypochloremic alkalosis, whereas values less than
4 mEq/L are associated with hyperchloremic acidosis.

Question 9

what is the common AG equation?

Answer 9

AG = Na + K - Cl + HCO3

Question 10

A decrease in what will result in a falsely decreased AG

Answer 10

Albumin - can be corrected with an equation utilising TP or alb

Question 11

What does the base excess algorithm assess

Answer 11

method to estimate
unmeasured strong ions
Values less than
-5 mmol/L are suggestive of an increase in unmeasured
strong anions

Question 12

What is the strong ion gap?

Answer 12

difference between all
unmeasured strong anion charges and all unmeasured
strong cation charges

Increase in unmeasured strong anions is suspected whenever
SIGsimplified is less than -5 mEq/L

Question 13

Mixed Acid-Base Disturbances Examples

Question 14

What is an example of a condition that may cause a resp acidosis and a metabolic alkalosis

Answer 14

gastric dilatation-volvulus that can present
with metabolic alkalosis caused by loss of gastric acid
and respiratory acidosis resulting from diaphragmatic
compression caused by the distended stomach.

Question 15

What is an example of a condition causing resp alk and metabolic acidosis

Answer 15

Dogs with heat stroke also initially have respiratory alkalosis
and later develop mixed respiratory alkalosis and
metabolic acidosis

Question 16

What are some examples of Metabolic Acidosis and Metabolic Alkalosis

Answer 16

Gastric dilatation-volvulus
Renal failure with vomiting
Vomiting and lactic acidosis

Question 17

Why may resp acid and metabolic acid occur concurrently?

Answer 17

commonly in acute severe
respiratory compromise (e.g., thoracic trauma, pulmonary
edema, cardiopulmonary arrest, acute neuromuscular
junctional disruption such as with toxic or metabolic
or junctionopathies) that also have lactic acidosis as a result of hypoxemia, shock, or poor cardiac output

Question 18

Why is bicarb admin contraindicated in patients with metabolic and resp mixed acidosis

Answer 18

they cannot excrete
the CO2 generated by NaHCO3 administration. The CO2 will diffuse into the cells and further decrease intracellular pH.

Question 19

What often causes a mixed hyperchloremic and high AG acidosis?

Answer 19

Renal disease.

The pH and
[HCO3 are low, and the diagnosis is suggested by an
increase in unmeasured anions and a chloride gap of less
than -4 mEq/L

Question 20

What is an example of a condition that may cause a triple mixed disorder?

Answer 20

GDV - can have metabolic alkalosis and lactic acidosis.29,37,61 These patients also can develop respiratory alkalosis as a result of a pain-induced increase in ventilation37 or sepsis.2 Respiratory acidosis also can develop if ventilation is impaired by a grossly overdistended stomach

Question 21

How should mixed disorders be treated?

Answer 21

1. treat the most life threatening abnormality first
2. treat the most treatable
3. direct pH manipulation not often required
4. always assess the pH
5. Always think about what treatment will do to the other abnormality