METABOLIC ACIDOSIS - values for bicarb and co2 and ph - three main causes - types

PH <7.35 LOW CO2 (bc respiratory compensation=hyperventilation to get rid of CO2 to raise ph) LOW BICARB <22 CAUSES 1. increased acid production 2. decrease acid excretion 3. Loss of HCO3 (diarrhea) can be HIGH ANION GAP ACIDOSIS or NORMAL ANION GAP ACIDOSIS

Renal: Acid Base Flashcards by Caroline Bouillon

what three processes must occur everyday in order to maintain acid base balance

buffering by ICF and ECF buffers
Alveolar ventilation to control PACO2
control of serum HCO3 via renal H+ excretion

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acid ph=

basic ph=

<7.3 acid

>7.45 alkalosis

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PCO2 is high or low with metabolic acidosis and alkalosis

acidosis = LOW PCO2 
alkalosis= HIGH PCO2

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what is the compensation for acidosis

a reduced CO2 partial pressure (PCO2) that should be predictable

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acidosis levels:

bicarb
pco2

low biacrb

low PCo2

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alklaosis
-PCO2
-Biacarb
levels

bicarb and PCO2 will be high

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where is most of the bicarb reabsorbed

proximal tubules MAINLY

little in the distal

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why is CO2 increased in metabolic alkalosis

because it is the comepnsatory mechanism done by the lungs

high bicarb=alkalosis state—so to compensate the lungs RETAIN CO2 to bring the pH back down

HIGH BICARB + HIGH CO2= met alkalosis with compensation

same for met acidosis
—>low bicarb—>kidneys want to excrete more CO2 to bring the pH Up

LOW BICARB + LOW CO2= MET ACIDOSIS with compensation

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describe amonias role in the kidney buffer system

ammonia NH3 picks up intracellular H+–> now becomes ammonium NH4+ (‘yum’ eats the H+)–>gets secreted into PCT–>excreted into CD

**for each H+ secreted there is a HCO3- gained in systemic circulation

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what is the osmolar gap

compares measured and calculated osmolality

Plasma osm (measured) - Plasma osm (calculated)

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METABOLIC ACIDOSIS

values for bicarb and co2 and ph
three main causes
types

PH <7.35

LOW CO2 (bc respiratory compensation=hyperventilation to get rid of CO2 to raise ph)
LOW BICARB <22

CAUSES

increased acid production
decrease acid excretion
Loss of HCO3 (diarrhea)

**can be HIGH ANION GAP ACIDOSIS or NORMAL ANION GAP ACIDOSIS

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Normal anion gap

define anion gap
equation

reflects unmeasured anions present in serum
AG= measured cations-measured anions (ECF)
AG= NA- (Cl+HCO3-)

10-12

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ways to lose bicarb aka what type of met acidosis?

NON ANION GAP ACIDOSIS

H-->hyperalimentation 
A-->acetazolamide 
R-->renal tubular acidosis 
D-->diarrhea 
U->ureero-pelvic shunt
P-->post-hypocapnia 
S-->spironolactone

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ways to gain acid

-aka causes of type of met acidosis?

HIGH ANION GAP ACIDOSIS

M--> methanol 
U-->uremia 
D-->DKA
P--> propyelen glycol 
I-->Isoniazid, infection 
L-->lactic acidosis 
E-->ethyelen gycol 
S--> salicylates

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high anion gap acidosis

*means there is an increase in some other acid (other than Cl-) in the serum
the H+ is buffered by the HCO3 but the other newly added acid is not buffered
*increasing the gap

*use winters formula is used to measure the respiratory compensation for met acidosis

{(1.5 X HCO3-) + 8}

MUDPILES= causes

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normal anion gap met acidosis

lab finding
causes

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low ph
low bicarb
low co2
normal AG

*lost bicarb is replaced by CL- so there is no change in AG but there is an accumulation of CL-
OR
*in cases of dirrhea or RTA–> loss of sodium bicarb and kidney tries to preserve volume by retaining NACL

HARDUPS=causes

CM for metabolic acidosis

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Cardiovascular

imparied contractility
decrease CO
vasodilation
Vasocontriction
arrhythmias

Respiratory

hyperventilation
resp muscle fatigue

Metabolic

hypercalcemia
hyperK

causes for high osmolar gap >20 mOsm/L

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TOXIC ALCOHOL INGESTIONS

methanol
ethanol
isopropanol
ethylene gylcol
propylene glycol
diethyelen glycol

causes for elevated osmolar gap but not >20

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alcoholik ketoacidosis
lactic acidosis
renal failure

equation for CALCULATED osmolality

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2 (NA+) + (Glucose/18) + (BUN/2.8)

explain why normal AG acidosis can occur

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if the acid that accumulates is HCL–>no change in the AG!

also called Hyperchloremic MA

two main causes for normal AG met. acidosis

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Loss of HCO3-
* diarrhea
* proximal RTA (2)
* ketoacidosis
Decreased acid secretion
* kidneys will filter and reabsorb HCO3- at prox tubules
* decr GFR
* distal (type 1) and Type IV RTA

urinary anion gap

-what is it

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distinguishes extra renal from renal causes of normal AG MA

what does a large -UAG mean

-cause

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metabolic acidosis of extra renal cause

diarrhea
assoc with incr excetion of NH4

what does a large + UAG mean | -cause?

metabolic acidosis of renal origin - NH4 excretion is minimal/impaired - distal renal tubular acidosis

levels for met alkalosis | -what is this often accompanied by?

HIGH: bicarb, ph and PaCO2 **hypocholoremia and hypoK ********bicarb can sometimes be normal or low

list two causes of elevated HCO3 and LOW CL-

metabolic alkalosis resp acidosis **need AGBs and electrolyte pannel to disntinguish the diff

causes of met. alklaosis

1. administration of alkali---antacids, citrate in blood transfusions 2. Chronic alkali administration---MILK ALKALI SYNDROME--> too much tums - ->nephrocalcinosis - ->renal insuff - ->CA Carbonate

hypoK does what to ammonium excretion

increases it

what is the compensation for met. alk

resp * hypoxemia * ***retain CO2 * hyPOventilation * increase in bicarb * paCO2 increases 6mmHg for each 10mEq/L increase in HCO3

how to calculate PaCo2

Bicarb + 15

two basic causes of met. alk

1. H+ decrease | 2. HCO3- increase

causes of H+ decrease aka met alk

1. renal loss of H+ - aldosterone causes acid secretion (secretes K and H) - hyperaldosteronism= incr secretion of acids--leaving behind basic environment 2. Shift of H+ into cells * H and K exchanged across cell membrane * in the state of hypoK--> K+ shifts out of the cells to balance K-->but H+ goes into cell as K+ leaves 3. vomiting * loss of H+

Causes of HCO3- increase aka met alk

1. increased intake 2. loss of acid * hyperaldosteronism 3. Volume depletion *contraction alkalosis *fluid with low bicarb [ ] is lost, leads to increase in bicarb [ ] EX: over diuresis

metabolic alkalosis phases

1. GENERATION * acid loss (ie vomiting or prolonged NG tube suction) * gain HCO3 (Primary hyperaldosteronism) 2. MAINTENANCE * kidney is unable to excrete HCO3 and instead absorbs it

CM of met alkalosis

HYPOK-->arrhythmias HYPOCA-->tremors, muscle cramps, tingling of fingers/toes hypochloremia ``` incr anxiety seizures confision HYPOventilation incr irritability ```

Renal: Acid Base Flashcards

(36 cards)