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16 Cards in this Set

  • Front
  • Back
What is the normal production rate of lactate?
1 mmol/kg/hour
What is the energy yield of anaerobic metabolism of glucose vs aerobic metabolism?
47kcal vs 673kcal
What is an abnormal resting blood lactate level?
What are the principle etiologies of lactic acidosis? (3)
1. oxygen deprivation associated with shock
2. endotoxemia - inhibits pyruvate dehydrogenase
3. thiamine deficiency - cofactor for pyruvate dehydrogenase
4. alkalosis - increases activity of pH-dependent enzymes in the glycolytic pathway
Is anion gap a useful screening test for possible lactic acidosis?
What is the principal fear in acidosis?
Risk of impaired myocardial contractility. But this is mitigated by ability of acidosis to stimulate catecholamine release and produce vasodilatation. Also, acidosis may have a protective role in the setting of clinical shock.
How do you calculate the bicarbonate deficit?
HCO3 deficit (mEq) - 0.6 x wt(Kg) x (desired HCO3 - measured HCO3)
Why is alkali therapy not particularly effective for acidosis?
Bicarbonate is not an effective buffer in the usual pH range of extracellular fluid. Its PK (dissociation constant) is 6.1.
What are some adverse effects of alkali therapy?
1. generates CO2 and raises the PCO2 - creates an acid load that must be excreted by lungs and reduces the buffering capacity of sodium bicarbonate
2. can produce hyperlacatemia - increasing function of enzymes in glycolysis
What are the two ketones generated with reduced nutrient intake?
acetoacetate and beta-hydroxybutyrate
Which ketoacid is detected by the nitroprusside reaction and what is the threshold for detection?
Why might the anion gap be normal in DKA?
renal excretion of ketones are accompanied by an increase in chloride reabsorption
What is the mgmt of DKA?
1. insulin - 0.1U/kg IV push, then 0.1U/kg/hr. decrease dose rate 50% when serum HCO3 rises above 16mEq/L
2. Fluid replacement - NS at 1L/hr for first two hours, then 0.5NS at 250-500cc/hr, when BG falls to 250mg/dL, can dextrose and drop rate to 100-250cc/hr
3. Potassium replacement - serum potassium falls dramatically during insulin therapy.
4. Phosphate - after four hours of therapy, if less than 1mg/dL replace with 7.7mg/kg over 4 hours.
How should DKA be monitored during therapy?
anion gap excess/bicarb deficit ratio - should start at 1.0 and resolve toward 0
What are the mechanisms involved with alcoholic ketoacidosis?
1. reduced nutrient intake enhances ketone production
2. hepatic oxidation of ethanol generates NADH and enhances beta-hydroxybutyrate formation
3. dehydration impairs ketone excretion in the urine
How is alcoholic ketoacidosis managed?
Infusion of dextrose-containing saline solutions.
Glucose retards hepatic ketone production, and volume promotes renal clearance of ketones. Replace electrolytes as needed.