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28 Cards in this Set
- Front
- Back
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What is normal bicarbonate concentration in blood at a pH of 7.4? |
24 mmol/L |
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What is normal hydrogen concentration in blood at a pH of 7.4? |
40 mmol/L |
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Step 1: How is internal consistency verified in blood gas measurments? |
Insert into the equation [H+] = 24 + ([CO2]/[HCO3-]) |
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Step 2: How is a secondary disorder discerned after a primary acid-base disorder has been determined? |
Use derangement equations for metabolic derangement and clinical context for respiratory derangements. Alkalosis: 0.6 x [HCO3]change |
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How do high-altitude dwellers differ from your average patient? |
Since they are adapted to lower partial pressures of oxygen, their lungs can compensate back up to 7.4 during primary acid-base disorders. |
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Which two metabolic disorders cannot coexist? |
Respiratory acidosis and respiratory alkalosis |
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What is the 3rd step in discerning acid-base co-disorders? |
Calculate the anion gap |
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What equation calculates anion gap? |
AGAP = [Na] - ([Cl] + [HCO3]) |
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What is the normal AGAP range? |
10 +/- 2 |
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In the anion gap, what protein constitutes the majority of negatively charged proteins in blood? |
Albumin |
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How much does the AGAP decrease for every 1g/dL of albumin decreased below 4.0g/dL serum? |
2.5 mEq/L |
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What pneumonic gives us metabolic acidosis etiologies for an increased anion gap? |
GOLDMARK |
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What does each letter in GOLDMARK stand for? |
Glycols (antifreeze) 5-Oxyproline (chronic acetaminophen) L-Lactate (iron tox) D-Lactate (bacteria) Methanol Asprin Renal failure Ketoacidosis (diabetes, alcoholic starvation)
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When uremia leads to metabolic acidosis, how high are BUN and [glucose]? |
BUN > 80
[glucose] > 600 |
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What is seen in the retina of a severe diabetic patient?
What causes these? |
Cotton-wool spots
retinal micro-infarctions |
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If AGAP is normal, what is the source of metabolic acidosis? (4) |
- G.I. (diarrhea or fistula) - Renal - Adrenal (Addison's) - Chloride acid in blood |
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When a diabetic patient with ketoacidosis is given insulin, what are the ketone bodies in blood converted to? |
Acetyl CoA, which then releases CO2 and thus bicarbonate |
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What is the 4th step for assessing metabolic acidosis? |
Delta ratio = change in AGAP / change in bicarb
DR = (AGAP-12) / (24-HCO3) |
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What does a Delta Ratio less than 1 mean?
1-2?
>2? |
<1 = High AGAP acidosis + normal AGAP acidosis
1-2 = high AGAP acidosis (~1.6 = lactic; ~1.1 ketone bodies)
>2 = High AGAP acidosis + metabolic alkalosis |
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What are the 2 most common etiologies of metabolic acidosis? |
- Vomiting - Diuretics |
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What effect does alkalosis have on hemoglobin oxygen affinity? |
Increases oxygen affinity (left-shift) |
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Between acidosis and alkalosis, which has higher mortality? |
alkalosis |
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What are 2 causes of chronic alkalosis? |
- High progestin (preg, cirrhosis) - High altitudes |
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What are 3 causes of acute alkalosis? |
- Primary hyperventilation - Early sepsis - Salicylate toxicity |
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What are the 2 categories of acidosis induction? |
Can't breathe and Won't breathe |
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What is a "Can't breathe" disorder? |
Damage to accessory neuromusculature of lungs |
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What is a "Won't breathe" disorder? |
Acidosis induced by drugs or brainstem damage (they may be comatose) |
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What 2 disorders can have a normal pH but a low pCO2? |
Metabolic acidosis or respiratory alkalosis |
