Pm_Renal_Intmed_Acid&base

Front 1

Pearl for Hypoxemia?
-Hypoxemia subnormal Oxy in Blood?

Back 1

Normal 02= 104 - .27*Age
=100 - 1/3 of Age
=decreases with age

Front 2

relevance of FIO2 on ABG

Back 2

Need to know %O2 to interpret

Front 3

What do you usually order to complement an ABG

Back 3

BMP (basic Meta Panel): Electrolyes, BUN, Creatinine
CMP (complete)- same plus Liver, Proteins, Globulins etc.

-not every time you get an ABG, but will get you started
---esp in pH disturbances or shock

Front 4

Give the Ranges and normal values of the ABG:
pH:
PaCO2
PaO2
HCO3
O2 Sat:

Back 4

pH: 7.4 (7.35-7.45)
PaCO2: 40; (35-45)
PaO2: 90; (80-100)
HCO3: 24; (22-26)
O2 Sat: 92-100%

Front 5

Massive pearl for Normal O2=

Back 5

104 -.27 x Age OR
100- 1/3 x Age

---note this will decrease with age

Front 6

What are some examples of Dz that cause Hypoxia via Diffusion abnormalities

Back 6

Interstitial Filtrates such as in :
Interstitial Lung Dz
Sarcoid Lung

Hint 6

Hyp

Front 7

3 Other common causes of Hypoxia?

Back 7

Hypoventilation
V/Q mismatch
Shunting
--of course altitude

Front 8

Define Acidosis and Alkalosis on ABGs?

Back 8

Acidosis: < 7.35
Alk: >7.45
ie .5 away from 7.4

Front 9

Define Hypoxia on ABG

Back 9

PaO2 < 60 mmHg

Front 10

Define Hypercapnia and Hypocapnia on ABG

Back 10

Hypercap: PaCO2 >45mmHg

Hypocap: PaCO2 < 35mmHg

--ie +/- 5 from normal of 40

Front 11

What is Formula for Anion Gap

Back 11

Na -
(Cl + BIcarb) / 12
= Gap +/- 2
--10-14 is normal

Front 12

What is purpose of Anion Gap?

Back 12

Reflects the [] of Anions that AREN't routinely measured
-ie: Sulfates, Phosphates, acetoacetic acid, beta hydroxybutric acid

Front 13

For Metabolic Acidosis, give general changes for:
pH
PaCO2
Bicarb

Back 13

pH dec
CO2 dec (same as pH = Metabolic)
Bicarb dec, dec

Front 14

What shows respiratory compensation in Metabolic Acidosis?
(3 options)

Back 14

dec CO2 = 1.2 for ea dec Bicarb
OR
PaCO2 = 1.5 x Bicarb + 8
OR
PaCO2 = decimal digits of pH

(sheet also shows: PaCO2= Bicarb + 15)

Front 15

For Metabolic Alkalosis, give general changes for:
pH
PaCO2
Bicarb

Back 15

pH: inc
CO2 inc (same as pH = Metabolic)
Bicarb: inc, inc

Front 16

What shows respiratory compensation in Metabolic Alkalosis?
(2 options)

Back 16

0.7 to 1 increases for PaCO2 : Bicarb
OR
6 to 10 increaes for PaCO2 : Bicarb

Front 17

For Respiratory Acidosis, acute, give general changes for:
pH
PaCO2
Bicarb

Back 17

pH dec
CO2 inc, inc (opp to pH = resp)
Bicarb inc

Front 18

What shows metabolic compensation in Respiratory Acidosis, acute?
(2 options)

Back 18

1 : 10 Increases of HCO3 for PaCO2
OR
0.8 dec to 10 inc of pH to PaCO2

Front 19

For Respiratory Acidosis, chronic, give general changes for:
pH
PaCO2
Bicarb

Back 19

same as acute:
pH dec
CO2 inc, inc (opp to pH = resp)
Bicarb inc

Front 20

What shows metabolic compensation in Respiratory Acidosis, Chronic?
(1 options)

Back 20

Chronic:

3-4 inc Bicarb for ea 10 inc PaCO2

Front 21

When do kidneys begin to retain Bicarb

Back 21

starts to retain bicarb in 12-16 hours, max [] in 1 week

Front 22

For Respiratory Alkalosis, Acute, give general changes for:
pH
PaCO2
Bicarb

Back 22

pH: Inc
CO2: dec, dec
Bicarb: dec

Front 23

What shows metabolic compensation present, given Respiratory Alkalosis, Acute?
(2 options)

Back 23

2 : 10 decreases in Bicarb : PaCO2
OR
.8 inc pH for ea 10 Dec in PaCO2

Front 24

For Respiratory Alkalosis, Chronic, give general changes for:
pH
PaCO2
Bicarb

Back 24

pH inc
CO2 dec (note just 1 dec)
Bicarb dec

Front 25

What shows metabolic compensation present, given Respiratory Alkalosis, Chronic?
(1 options)

Back 25

4-5 Bicarb dec for ea 10 dec PaCO2

(note this is 1 bracket higher, ie more bicarb change than in Resp Acidosis)

Front 26

MORE IMPORTANT stuff now.
What are 3 commonest causes of Metabolic Acidosis?
(hint--relates to Bicarb, to H load, to H excretion)

Back 26

1. Loss of Bicarb --ie in GIT or Renally
2. Inc. H+ Load
3. dec. H+ Excretion

Front 27

What are commonest causes of Inc. H+ load leading to Metabolic Acidosis?

Back 27

Diabetic Ketoacidosis or
Lactic Acidosis
= Meta Acid

Front 28

What are commonest causes of Dec. H+ Excretion leading to Metabolic Acidosis?

Back 28

Uremic Acidosis or
Renal Tubule A?

Front 29

What are the 2 types of Metabolic Acidosis?

Back 29

Elevated Anion Gap Met. Acidosis
-
Normal Anion Gap Meta Acidosis with Hyperchloremia

Front 30

If Elevated Anion Gap Meta Acidosis, what is considered?

Back 30

MUDPILES

Front 31

What are the MUDP in MUDPILES

Back 31

Methanol--> formic acid
Uremia
-inc BUN, Creat
-inc Sulfates, PO4s,/ other unmeasured anions
Diabetic Ketoacidosis
-inc Glc, starvation, ETOH
-Ac Acid, Beta hydroxybutric Acid
Paraldehyde

Front 32

What are the ILES in MUDPILES

Back 32

Isoniazid / Iron
--TB drug, Iron decoupling
Lactic Acid
--shock, sepsis, low perfusion
Ethylene Glycol
Salicylates

Front 33

What are common ones to think of in emergency/abuse for Elevated Anion Gap Meta Acidosis

Back 33

M, E and S
Methanol consump.
Ethylene Glycol (antifreeze)
Salicylates---aspirin poisoning

Front 34

What is acronym to consider when Normal Anion Gap Metabolic Acidosis?

Back 34

HARDUPS

Front 35

What are the HARD letters for in HARDUP of Normal AGap Meta Acidosis?

Back 35

Hyperalimentation --due to TPN
Acid Infusion
-acetazolamide (carbonic anhydrase ibx drug)
R - RTA -renal los of Bicarb
D- Diarrhea
--losing Bicarb, Losing K_

Front 36

What are the UPS for in HARDUPS for Normal AGap Metabolic Acidosis?

Back 36

U-Ureteral Sigmoid or ileal diversion--losing Bicarb in GIT
P- Pancreatic Fistula --losing bicarb, losing K+
S - Spironolactone (aldactone) - a diuretic and antiandrogen drug

Front 37

In addition to underlying cause, what Tx must be considered with Metabolic Acidosis?

Back 37

Tx of CV compromise,
ie if pH < 7.2, Bicarb < 10
give Bicarb,
Deficit =( 24 - Measured) x (.5 x wt in kg)

Front 38

How much bicarb do you administer in metabolic acidosis?
how's it given?

Back 38

Deficit =( 24 - Measured) x (.5 x wt in kg)

Rx= NaHCO3 1 amp 8.5%, 50 mEq/50cc tablet

Front 39

With Metabolic Alkalosis, where compensation is respiratory retention of .7 PaCO2 for every 1 Inc of Bicarb, what acronym must be considered?

Back 39

CLEVER PD

--give the causes of

Front 40

List some common causes of Metabolic ALkalosis?

dont worry too much about this and next 2 cards

Back 40

Cl loss
Bicarb Excess
Volume Contraction

Front 41

Cl- Loss causing Metabolic Alkalosis via

Back 41

Cl Loss: Vomiting,
N/G Suction
villous adenoma
diuretics

Front 42

Bicarb Excess causing Metabolic Alkalosis via

Back 42

Bicarb Exces: enhanced HCO3 resorption (hyperaldo, licorice excess

Front 43

What do letters of CLEVER PD stand for when considering Metabolic Alkalosis?

Back 43

Contraction (volume)
Licorice
Endocrine (conns, cushings, barters dzz)
Vomiting
Excess Alkali
Refeedind Alkalosis

POst Hypercapnia
Diuretics

Front 44

What are 2 types of Metabolic Alkalosis?

Back 44

Cl Responisive
---do give them saline
and
Cl- Unresponsive
--pouring out Cl, so don't give saline. Gotta Tx condition

Front 45

Indication that metabolic alkalosis is Cl Responsive, ie can tx with Cl-

Back 45

Urine Cl < 10-20 mEq/L
--improves with NaCl and Volume
-dec Serum Cl and Volume Contaction
---caused by vomiting, NG suction, diuretics???

Front 46

Indication that metabolic alkalosis is Cl Unreesponsive, ie cannot tx with Cl-

Back 46

Urine Cl > 10-20 mEq
-UEndrocrine causes: Bartlers, Severe K deplection, hyperaldo, cushings

Give SPironolactone--- spares K+ and Ibx Androgen Hormones

Front 47

What are 3 main Tx options for Metabolic Alkalosis

Back 47

1. Tx underlying cause
2. NaCl, KCl, Mg
3. Spironolactone for Mineralocorticoid Excess (too much aldo)

Front 48

Moving on to Respiratory Acidosis.
What are commonest causes?

Back 48

Anything that causes Hypoventilation:
CNS depression, drugs, CVA, Neuromuscular Airway Obstruction, Pneumonia, Pul Edema, Pneumothorax, COPD, Restrictive Dzz

Front 49

Tx for Respiratory Acidosis
1st step, then 3 options

Back 49

1. Establish Airway/ suction
2. Aerosol tx, beta agonist, ventilator

Front 50

What are main causes of Respiratory Alkalosis?

What is acronym

Back 50

Anything that causes
HYPERventilation

CHAMPS used with Resp. Alk

Front 51

What does CHAMPS stand for in Respiratory Alkalosis?

Back 51

C- CNS Dz
H- Hypoxia
A- Anxiety
M- Mechanical Ventilation
P- Progesterone
S- Salicylates/sepsis

Front 52

WHat is another type of acidosis?

Back 52

Lactic Acidosis
-Type A and Types B (B1, B2, B3)

Front 53

What is Type A Lactic Acidosis

Back 53

aka Tissue Hypoxia --shock, severe anemia, HF, CO poison

Front 54

What are Types B1-B3 of Lactic Acidosis

dont worry to much about theses

Back 54

B1--assc/ systemic Dzo: DM, liver failure, sepsis, seizures
B2--assc/ drugs/toxins: ETOH, Methanol, Antifreeze, ASAs
B3--assc/ metabolic dzo---G6PD deficiency

--notes say GGPD, typo?

Front 55

What are johnstons 3 steps for ABG analysis

Back 55

1. Acid or Alkali
2. Repspiratory (pH and CO2 opp) OR Metabolic (pH and CO2 change same direction)
3. Is it Pure Respiratory Process, or is there some Metabolic Component too (or vversa)

Front 56

KNOW THIS:
If its a Pure Respiratory Process (where pH and CO2 move in opp directions), what will be the respective values of changes in CO2 and pH

Back 56

Fore each 10mmHg change in PaCO2, there should be an OPP move in pH by 0.08 (+/- .02)

Important

Front 57

If its a Respiratory PRocess and the change in PaCO2 by 10 is not met by .08 (+/- .02) change in OPP direction by pH, then what?

Back 57

There is a Mixed Process where Metabolic acidosis is further depressing the pH or Metabolic Alkalosis is further increasing the pH

depending on what the pH SHOULD be based on PaCO2 changes in 10mmHg increments

Front 58

END of LEcture NOTEs
Dont be a dick and?

Back 58

Go do a few Examamples starting on page 26