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19 Cards in this Set
- Front
- Back
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What is the first and second step in determining an acid/base disorder?
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1) pH 2) pCO2 and HCO2
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What is the differential for an elevated anion-gap metabolic acidosis?
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MUDPILES (Methanol, Uremia, DKA/Drugs, Phosphate, Ischemia/INH, Lactate, Ethylene glycol, starvation/salicylates)
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What is the differential for a normal anion gap metabolic acidosis?
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DURHAM (Diarrhea, Ureteral diversion, RTA, Hyperalimentaion, Addison's/Acetazolamide/Ampho, Misc
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How is the anion gaP affected by albumin?
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The anion gap decreases by 2.5 for every decrease in alb by 1
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How can you evaluate for a concurrent normAl anion gap and elevated gap metabolic acidosis?
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By using the delta-delta. The change in bicarbonate should equal the change in The anion gap.
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what are the two likely causes of low anion gap met acidosis?
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low albumin and multiple myeloma
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How is the urine anion gap measured?
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(Na+K)-Cl.
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What is the significance of an elevated urine anion gap (greater than zero)?
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A urine anion gap greater than zero signifies the kidney is not excreting acid appropriately, and there is either type 1 or type 4 renal tubular acidosis is present.
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how is respiratory compensation in metabolic acidosis calculated? Is this method appropriate for metabolic alkalosis?
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pCO2=1.5(HCO3)+8 +/- 2. It is only valid for met acidosis
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What four toxic substances (solvents) can cause an osmolar gap? Which cause delirium? Which cause ketosis? Which causes normal gap met acidosis?
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Methanol, Ethylene Glycol, Isopropyl alcohol and Toluene cause an osmolar gap. Methanol and Ethylene glycol cause delirium. Isopropyl alcohol causes ketosis (but not an acidosis). Toluene causes an elevated anion gap, but also causes an RTA, so a normal anion gap acidosis also develops.
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What toxic osmolarly active substances cause delirium and an elevated gap metabolic acidosis? How are they distinguished?
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Methanol and Ethylene glycol cause osmolar gap, metabolic acidosis and delirium. They are distinguished in that methanol causes papillodema and retinal hemorrage, and ethylene glycol causes oxalate crystals in the urine.
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How is predicted serum osmolarity calculated? How is the osmolar gap calculated?
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2(Na)+(BUN/2.8)+Glc/18. The gap is calculated by subtracting the serum osmolarity from the predicted. Normal should be less than 10.
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What two states produce metabolic acidosis (what is the pathophys)?
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Hypovolemic states (the kidney holds onto sodium (and water) and uses HOC3- to maintain neutrality) and hypermineralcorticoid states (causing excess H+ excretion)
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How is metabolic alkalosis differentiated? What are the other names for these two alkaloses?
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urine chloride. if less than 10, the alkalosis is due to hypovolemia. If greater than 10, the alkalosis is due to hypercorticoid states. Low urine chloride alkalosis is also called "saline responsive," normal urine chloride is called "saline resistant"
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What is used to differentiate saline resistant met alkalosis?
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The presence of hypertension. Hypertensive patients have Cushing's, Conn's and renal artery stenosis. Patients without hypertension is due to low Mg, K or bartlett syndrome.
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How is respiratory compensation determined in respiratory alkalosis?
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CO2 increases by 0.5-1 for every 1 increase in HCO3 from 24.
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What is the expected change in pH and HCO3 in acute and chronic respiratory acidosis?
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pH should decrease by 0.8 and HCO3 increases by 1 for every increase by 10 in acute respiratory acidosis. pH should decrease by 0.03 and HCO3 increase by 3-4 for an increase in 10 for chronic alkalosis.
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What is the expected HCO3 compensation in acute and chronic respiratory alkalosis?
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An increase in pCO2 of 10 should produce an decrease in HCO3 of 2 in acute cases, and 5 in chronic cases.
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What condition causes both an elevated gap metabolic acidosis and an respiratory alkalosis?
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Salicylate toxicity
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