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52 Cards in this Set
- Front
- Back
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pH =
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Negative log of free hydrogen ion concentration (usually 40 mmol)
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Acidemia and Alkalemia pH?
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Acidemia = pH < 7.4
Alkalemia = pH > 7.4 |
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Draw out the chart for primary disorders in metabolic and resp disturbances...NOW
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draw the A/B chart with pCO2 and pH
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pH: 7.3 pCO2 30
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Metabolic acidosis
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pH: 7.3
PCO2: 47 |
Respiratory acidosis
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pH: 7.45
PCO2: 47 |
Metabolic alkalosis
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pH 7.45
PCO2: 30 |
Respiratory alkalosis
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pH: 7.24
PCO2: 60 primary disorder? HCO3: 20, secondary disorder? |
Primary: Resp acidosis
Secondary: metabolic acidosis (norm is 22-30, so it was low) |
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when do you calculate an anion gap?
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metabolic acidosis
Cations=anions Na - (Cl + HCO3) |
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normal anion gap?
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12-16
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An increase in the Anion Gap indicates the presence of other unmeasured
anions. This is usually (but not always) associated with.... |
a fall in serum bicarbonate – as in metabolic acidosis.
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normal anion gap with metabolic acidosis
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hyperchloremic
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wide anion gap with metabolic acidosis
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normochloremic
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delta delta =
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change in the anion gap and the change in the plasma HCO3 concentration or
Δ AG/ Δ HCO3 |
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if delta ratio is 1-2
what do you have? |
Pure High AG
Metabolic Acidosis |
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if delta ratio is <1
what do you have? |
High AG acidosis +
Hyperchloremic Metabolic Acidosis |
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if delta ratio is >2
what do you have? |
High AG acidosis +
Metabolic Alkalosis |
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Na+ = 140
Cl- = 102 HCO3 = 16 AG = 22 Δ AG=? Δ HCO3 (if 24 is normal) = D/D ratio? Dx? |
Δ AG = 10
Δ HCO3= 8 Δ Δ = 10/8 = 1.2 Dx: Pure High AG Metabolic Acidosis |
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Example # 2
Na+ = 132 Cl- = 104 HCO3 = 8 AG = 20 AG=? change in HCO3 (if 24 is normal) = D/D ratio? Dx? |
Δ AG = 8
Δ HCO3= 16 Δ Δ = 8/16 = 0.5 Dx: High AG + Hyperchloremic Metabolic Acidosis |
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Na+ = 144
Cl- = 96 HCO3 = 14 AG = 34 AG=? change in HCO3 (if 24 is normal) = D/D ratio? Dx? |
Δ AG = 22
Δ HCO3= 10 Δ Δ = 22/10 = 2.2 Dx: High AG + Metabolic Alkalosis |
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Causes of high AG metabolic acidosis
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Methanol
Uremia DKA Paraldehyde INH Lactic Acidosis Ethylene glycol Salicylates |
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list 3 major causes of normal AG metabolic acidosis
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GI loss of HCO3 (diarrhea)
Renal loss of HCO3 (RCAs) HCL/HCL precursor ingestion |
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Cl levels can be a cause of metabolic alkalosis... there are 2 types...
chloride responsive has what level of urinary Cl? what about unresponsive? |
<20 mEq/L --> chloride responsive
>20 mEq/L -->chloride unresponsive |
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Diuretics (remote)
Vomiting Gastrointestinal suction Status post chronic hypercarbia are causes of what |
chloride responsive metabolic alkalosis
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Diuretics (recent)
High blood pressure low BP are causes of what? |
chloride UNponsive metabolic alkalosis
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CNS depression
Neuromuscular disorders Thoracic cage restriction Impaired lung motion Acute obstructive pulmonary disease COPD causes of? |
respiratory acidosis
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Anxiety
Stroke Hormones Drugs Sepsis Hyperthyroidism Pregnancy causes of ? |
respiratory alkalosis
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a decrease in anion gap means what?
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we have a decrease in Na (due to lab error)
or decreased unmeasured anions increased unmeasured cations because UA-UC=anion gap |
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what does Decreased Unmeasured Cations do to the AG?
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UA - UC =
Serum Anion Gap so increases anion gap |
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what does increased unmeasured cations do to AG?
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UA - UC =
Serum Anion Gap Decreased Anion Gap |
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what do Decreased Unmeasured Anions do to the AG
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UA - UC =
Serum Anion Gap Decreased Anion Gap |
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For each Gram drop in serum albumin, the anion gap decreases by a factor of ___
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2.5
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what is your anion gap if your serum albumin is 4.5?
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12
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what is your anion gap if your serum albumin is 3.5?
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9.5
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what is your anion gap if your serum albumin is 2.5?
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7
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what is your anion gap if your serum albumin is 1.5?
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4.5
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true AG = ?
when do you calculate it? |
True AG = [(4.5 – Serum Alb) X 2.5] + AG
when albumin drops below 3 (4 is normal) |
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normal urinary anion gap?
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-10 to 10
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As NH4 excretion increases, what happens to urinary chloride excretion?
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it must increase as well
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Cl excretion does what to the urine anion gap?
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As chloride excretion increases, urinary anion gap becomes more negative
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when you lose bicarb from the kidney, what happens to NH4 excretion? what happens to the urine anion gap?
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Ammonium excretion decreased
Urine anion gap becomes positive |
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when you lose bicarb from the GI, what happens to NH4 excretion? what happens to the urine anion gap?
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Ammonium excretion increased
Urine anion gap becomes negative |
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what is the osmolar gap?
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The difference between the measured and calculated serum osmolality
Calculated Posm = 2 x[plasma Na] + [BUN]/2.8 + [Glucose]/18 measured when you have a met acidosis that is not caused by lactic acid or ketones |
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if you have a metabolic acidosis with a high anion gap, and it is not due to ketones or lactic acid, what do you have to do?
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calculate the osmolar gap
Calculated Posm = 2 x[plasma Na] + [BUN]/2.8 + [Glucose]/18 |
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An osmolar gap of over ____ indicates the presence of other osmolarly
active substances in the blood |
20
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what will the urine pH be like in Type I-III in RTA?
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Type II: acid
Type I: alkaline Type II: Acid |
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in what type RTA will kidney stones be present?
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only in type I
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In what RTA is Fanconi syndrome present?
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Type II
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what is the urine anion Gap for type I, II, IV
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positive
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please draw out the overall chart for how to figure out an acid base disturbance
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how do you calculate urinary ion gap
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Na + K - Cl = Urinary Anion Gap
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