P3 Therapeutics Test 1 Acid/base

Front 1

what happens to pH and HCO3 when you have metabolic acidosis

Back 1

decrease pH
decrease HCO3

Front 2

what is the purpose of anion gap

Back 2

differentiates the different etiologies of metabolic acidosis

Front 3

what is the equation for AG

Back 3

Na - (Cl +HCO3)

Front 4

when anion gap increases what happens

Back 4

1 mEq increase in AG
1 mEq decrease in HCO3-

Front 5

when anion gap is normal what happens

Back 5

1mEq increaes in CL
1mEq decrease in HCO3-

Front 6

what are the causes of elevated AG

Back 6

M-methanol/ethanol
U-uremia
D-dka

P-paraldehyde ingestion
I-ischemia causing lactic acidosis
L-lactic acidosis causing hypoxia, hypotension, sepsis
E-ethylene glycol, proprylene glycol
S-salicylates

Front 7

what is the normal range of AG

Back 7

9-12

Front 8

what are the causes of normal AG (hyperchloremia)

Back 8

D-diarrhea
U-urethral diversion
R-renal tubular acidosis
H-hyperalmination
A-ammonium chloride, acetazolamide
M-misc pancreatic fistula

Front 9

when is lactic acidosis considered to be present in a acidemic pt

Back 9

when lactate exceeds 4-5mEq/L

Front 10

osmotic gap greater than what indicates presence of toxin

Back 10

OG > 10

Front 11

what is the equation for osmotic gap

Back 11

OG = serum osmolality - calculated osmolarity

Front 12

Nasogastric tube causes loss of what

Back 12

Cl

Front 13

Ostomy causes loss of what

Back 13

HCO3

Front 14

where is Cl primarily found

Back 14

upper part of the body

Front 15

where is HCO3 primarily found

Back 15

lower part of the body

Front 16

what is the urine pH usually

Back 16

<5.5

Front 17

when the serum is acidemic what should happen to your urin

Back 17

it should become maximally acidic as your body is trying to excrete the acid

Front 18

if you are acidemic but your urine is >5.5 what could be a cause

Back 18

Renal Tubula Acidosis

this is due to the kidney inappropriately secreting HCO3

Front 19

what will be your NH4 levels in the urine if you have RTA

Back 19

NH4 lower than expected
Cl will be lower than expected as well

Front 20

what are your HCO3, Cl, K, and glucose levels in metabolic acidosis

Back 20

decrease HCO3
increase Cl
normal or increased K
glucose may be high if metabolic acidosis is due to DKA

Front 21

what are some of the clinical manifestations that can be seen with metabolic acidosis

Back 21

hyperventilation
hyperkalemia
coma

Front 22

how do you treat chronic metabolic acidosis

Back 22

gradually fix over days to weeks
tx by giving bicarbonate or something that gets metabolized to bicarbonate

Front 23

what is the pH for chronic metabolic acidosis

Back 23

7.2-7.35

Front 24

what is the pH of acute severe metabolic acidosis

Back 24

<7.2

Front 25

what are the bicarb levels in severe metabolic acidosis

Back 25

<9

Front 26

how do you treat acute severe metabolic acidosis

Back 26

Bicarbonate admin
-50mEq/50ml
-replace no more than 1/2 of deficit in 1st 24hrs
-goal HCO3 >10 pH >7.2

Tromethamine
-potent H+ acceptor
increases urine flow, urine pH, and excretion of CO2, electrolytes, and fixed acids

Front 27

what happens if you replace more than half of the bicarb deficit in the first 24 hours when treating metabolic acidosis

Back 27

hypernatremia
hypokalemia
volume overload

Front 28

what happens to your pH and HCO3 levels in metabolic alkalosis

Back 28

increase pH
increase HCO3

Front 29

what are the types of metabolic alkalosis

Back 29

saline responsiveness
saline non responsiveness

Front 30

what is your urine Cl in saline responsive metabolic alkalosis

Back 30

<10

Front 31

what is your urine Cl in saline resistant metabolic alkalosis

Back 31

>20

Front 32

what are the causes of saline responsive Metabolic alkalosis

Back 32

D-diarrhea
A-adenoma of colon
M-misc bulemia

P-posthypercapnia
E-emesis
N-nasogastric tube

Front 33

what are the causese of saline nonresponsive metabolic alkalosis

Back 33

A-alkalai ingestion w/ decrease GFR

B- 11 B hydroxylase defficiency
E-exogenous steroids: Na retention, K/H+ excretion
L-licorice ingestion
C-cushings syndrome/disease
H-hyperaldosteronism

Front 34

what is the clinical presentation with metabolic alkalosis

Back 34

arrhymias
pH > 7.6 causes vasoconstriction

Front 35

pH of what causes vasoconstriction

Back 35

7.6

Front 36

what are your BUN, HCt, Cr, Cl levels in metabolic alkalosis

Back 36

increased BUN, Cr, and Hct
Cl is normal or decreased

Front 37

how do you treat metabolic alkalosis

Back 37

volume replacement
saline and KCl
HCl
ammonium chloride
acetazolamide
H2 antagonist
dialysis

Front 38

if you body is holding onto CO2 what disorder do you have

Back 38

respiratory acidosis

Front 39

what are some causes of acute respiratory acidosis

Back 39

pneumonia
smoke inhallation
pulmonary edema

Front 40

what are the causes of chronic respiratory

Back 40

bronchitis
emphysema
asthma

Front 41

what are the treatments for acute respiratory acidosis

Back 41

artificial ventillation

Front 42

what are the treatments for chronic respiratory acidosis

Back 42

low flow O2
respiratory stimulant (Ritalin)

Front 43

what are causes of respiratory alkalosis

Back 43

pneumonia
hyperventilation

Front 44

how do you treat respiratory alkalosis

Back 44

ventilation
respiratory depressants