Step U - Underlying Cause

Question 1

What are the four causes of acid/base abnormality?

Answer 1

• respiratory acidemia
• respiratory alkalemia
• metabolic acidemia
• metabolic alkalemia

Question 2

In respiratory acidemia, cerebral blood flow may ____ with an increase in carbon dioxide

Answer 2

more than double

Question 3

What are the signs of high CO2?

Answer 3

• increased CMO
• tachycardia
• skin flushed
• diaphoretic
• bounding pulse

Question 4

Blood flow is ____ with chronic hypercapnia

Answer 4

normal

Question 5

What are two signs of severe hypercapnia?

Answer 5

• hypotension

- arrhythmias

Question 6

What is the acronym for respiratory acidemia (increase in volatile acids)?

Answer 6

C O N V E N I E N T

Question 7

What does the C in respiratory acidemia stand for?

Answer 7

COPD code

Question 8

What does the O in respiratory acidemia stand for?

Answer 8

oxygen excess in COPD

Question 9

What does the 1st N in respiratory acidemia stand for?

Answer 9

neuromuscular disorders (MG, GB, ALS, polio)

Question 10

What does the V in respiratory acidemia stand for?

Answer 10

V/Q mismatch (lung cancer)

Question 11

What does the 1st E in respiratory acidemia stand for?

Answer 11

exhaustion (status asthmaticus)

Question 12

What does the 2nd N in respiratory acidemia stand for?

Answer 12

neurological disorders (central sleep apnea, intracranial hypertension)

Question 13

What does the I in respiratory acidemia stand for?

Answer 13

inadequate CMV (hyperkalemia)

Question 14

What does the 2nd E in respiratory acidemia stand for?

Answer 14

excessive CO2 production (permissive hypercapnia, burns, sepsis)

Question 15

What does the 3rd N in respiratory acidemia stand for?

Answer 15

narcotics and other CNS depressants

Question 16

What does the T in respiratory acidemia stand for?

Answer 16

trauma to the respiratory center

Question 17

What should you do on patients who have a neuromuscular disorder?

Answer 17

• NIF

- VC

Question 18

What are the signs and symptoms of respiratory alkalemia?

Answer 18

• tingling
• numbness of hands and feet
• tachycardia
• increased CMO

Question 19

In respiratory alkalemia, cerebral blood flow is ____

Answer 19

decreased

Question 20

What is the acronym of respiratory alkalemia?

Answer 20

H O R N S

Question 21

What does the H in respiratory alkalemia stand for?

Answer 21

hypoxemia

Question 22

What does the O in respiratory alkalemia stand for?

Answer 22

overzealous mechanical ventilation

Question 23

What does the R in respiratory alkalemia stand for?

Answer 23

restrictive lung disorder (stimulates faster breathing)

Question 24

What are some examples of restrictive lung disorders that cause respiratory alkalemia?

Answer 24

• fibrosis
• CHF
• ARDS
• pneumonia

Question 25

What does the N in respiratory alkalemia stand for?

Answer 25

neurologic disorders

Question 26

What are some examples of neurologic disorders that cause respiratory alkalemia?

Answer 26

- infection - trauma - salicylates - drugs

Question 27

What does the S in respiratory alkalemia stand for?

Answer 27

septicimia

Question 28

What drug is used to stimulate the diaphragm in patients with COPD?

Answer 28

aminophylline

Question 29

What is the acronym for metabolic acidemia caused by an increased in fixed acids?

Answer 29

T A L K

Question 30

What does the T in metabolic acidemia stand for?

Answer 30

Toxins

Question 31

What are some examples of toxins that cause metabolic acidemia?

Answer 31

- salicylates - wood alcohol - antifreeze - toluene

Question 32

What does the A in metabolic acidemia stand for?

Answer 32

azotemic renal failure

Question 33

What are the 3 phases of renal failure?

Answer 33

pre intra post

Question 34

What are indicators that a patient is in pre renal failure?

Answer 34

- BUN >80 - creatinine unaffected - SP > 1.02 - dark urine - hypotension or hypovolemia

Question 35

What are indicators that a patient is in intra renal failure?

Answer 35

- BUN >80 - creatinine >8 - SP <1.015 - clear urine

Question 36

What are indicators that a patient is in post renal failure?

Answer 36

- low urine output (if any, usually bloody) | - BUN and creatinine cannot be measured

Question 37

What drug is given to a patient in metabolic acidemia?

Answer 37

lasix

Question 38

What drug is given to a patient in metabolic alkalemia?

Answer 38

diamox

Question 39

What is the only exception in decrease in bases due to buffering?

Answer 39

chloride

Question 40

What does the L in metabolic acidemia stand for?

Answer 40

lactic acid (most common and caused by hypovolemia)

Question 41

What are some examples that cause an increase in lactic acid?

Answer 41

- hypoxemia - ethanol intake - liver damage - poisonings

Question 42

What are the causes of an increase in protein metabolism?

Answer 42

- bleeding into stomach - corticosteroids - increase in protein intake - infection - starvation - surgery - trauma

Question 43

What are the causes of a decrease in excretion of protein?

Answer 43

- dehydration - vomiting - diarrhea

Question 44

What should you look at to assess kidney function and what is the normal range?

Answer 44

creatinine; 0.5-1.5

Question 45

What does the K in metabolic acidemia stand for?

Answer 45

keto acidosis (diabetic crisis)

Question 46

What are the causes of keto acidosis?

Answer 46

- hyperglycemia - glycosuria - ketouria

Question 47

What is glycosuria?

Answer 47

excess glucose in urine

Question 48

What are the signs/symptoms of keto acidosis?

Answer 48

- vomiting - hyperkalemia - kussmauls breathing - boryborgymus

Question 49

What is boryborgymus?

Answer 49

swelling of the stomach

Question 50

What is ketouria?

Answer 50

accumulation of ketone bodies

Question 51

What are the causes of metabolic acidemia due to a decrease in bases?

Answer 51

- renal tubular acidosis - enteric fluid loss - diamox

Question 52

What are the ways or diseases that cause a to have enteric fluid loss?

Answer 52

- biliary or pancreatic disease - enteric drainage tubes - diarrhea - sustained deep vomiting

Question 53

What is the acronym for metabolic alkalemia?

Answer 53

H I G H B A S E

Question 54

What does the 1st H in metabolic alkalemia stand for?

Answer 54

hypokalemia, hypochloremia, hypovolemia

Question 55

What does the I in metabolic alkalemia stand for?

Answer 55

ingestion of base (milk, excessive bicarb, chewing tobacco)

Question 56

What does the G in metabolic alkalemia stand for?

Answer 56

gastric fluid loss (NG tube)

Question 57

What does the 2nd H in metabolic alkalemia stand for?

Answer 57

hyperaldosterone (increase in aldosterone increases your level of sodium bicarb)

Question 58

What does the B in metabolic alkalemia stand for?

Answer 58

blood transfusion

Question 59

Why does a blood transfusion cause metabolic alkalemia?

Answer 59

in stored blood, there is an anticoagulate called citrate. when a person metabolizes citrate, it is converted to bicarb and s/he ends up with metabolic alkalemia

Question 60

What does the A in metabolic alkalemia stand for?

Answer 60

adrenocortical hypersecretion (increase in sodium bicarb absorption)

Question 61

What does the S in metabolic alkalemia stand for?

Answer 61

steroids (increase in sodium bicarb absorption)

Question 62

What does the E in metabolic alkalemia stand for?

Answer 62

eucapnic ventilation post hypercapnia (buffering left over from metabolic acidemia)

Question 63

How many steps are there for highbase?

Answer 63

4

Question 64

What is the 1st step for highbase?

Answer 64

look for high base intake

Question 65

What is the 2nd step for highbase?

Answer 65

look for any diuretic therapy

Question 66

What is the 3rd step for highbase?

Answer 66

check hydration status (dehydration = increase in aldosterone)

Question 67

What is the 4th step for highbase?

Answer 67

check for adrenal disease