Renal - Acid/base Interpretation

Front 1

Normal values for pH, PCO2, PO2, HCO3-, O2 sats:

Formula for normal PO2?

Causes of hypoxia?

Back 1

pH 7.4, PCO2 40, PO2 90, HCO3- 24, O2 92%-100%

100 - (1/3)age

V/Q mismatch - COPD, pneumonia, shunting (ARDS), diffusion abnormalities (Hamman Rich, sarcoid), hypoventilation, low O2 fraction, high altitude

Front 2

Acidosis = pH < ?
Alkalosis = pH > ?
Hypoxia = pO2 < ?
Hypercapnia = pCO2 > ?
Hypocapnia = pCO2 < ?

ABG normals for Na, K, Cl, CO2?

Anion gap calculation? What's normal?

Back 2

acidosis = pH <7.35
alkalosis = pH > 7.45
hypoxia = pO2 < 60
hypercapnia = pCO2 > 45
hypocapnia = pCO2 < 35

ABG - Na 140, K 4, Cl 103, CO2 24

AG = [Na] - [Cl + CO2]
normal = 10-14

Front 3

pH, CO2 go in opposite directions:

pH, CO2 go in same direction:

respiratory compensation for metabolic acidosis,alkalosis:

metabolic compensation for acute respiratory acidosis, alkalosis:

Back 3

respiratory acidosis/alkalosis

metabolic acidosis/alkalosis

met acid: down 1.2 pCO2/1 HCO3-
met alka: up 0.7 pCO2/1 HCO3-

resp acid: up 1 HCO3/10 PCO2, pH down 0.8/10 PCO2
resp alka: down 2 HCO3/10 PCO2, pH up 0.8/10 PCO2

Front 4

metabolic compensation for chronic resp. acidosis, alkalosis:

RTA Type I: where, what's affected, causes?

RTA Type II: where, what's affected, causes?

Back 4

resp acid: up 3-4 HCO3/10 PCO2
resp alka: down 4-5 HCO3/10 PCO2

RTA Type I: distal tubule, low acid secretion to urine, Sjogren's, SLE

RTA Type II: proximal tubule, low absorption of HCO3-, myeloma, heavy metal poisoning, Wilson's

Front 5

Causes of AG metabolic acidosis? (CT MUDPILES)

Back 5

CO, cyanide
Toluene poisoning
Methanol
Uremia
DKA
Paraldehyde
INH, Iron
Lactic acidosis
Ethylene glycol
Salicylate

Front 6

Causes of non-AG metabolic acidosis? (HARDUPS) - general mechanism?

Back 6

loss of HCO3-

Hyperalimentation
Addison's, acetazolamide
RTA
Diarrhea
Ureteral/ileal diversion
Pancreatic fistula
Spironolactone

Front 7

How do you measure the HCO3 deficit in a met. acidosis pt?

Treatment?

Metabolic alkalosis - general acid/base problem?

Two most common causes of met. alkalosis?

Back 7

HCO3 deficit = desired HCO3 - measured HCO3 (.5x wt in kg)

NaHCO3

Cl- loss, HCO3- excess

vomiting, diuretics

Front 8

Causes of metabolic alkalosis? (CLEVER HD)

Back 8

Contraction (volume)
Licorice
Endocrine (Conn's, Cushing's, Bartter's)
Vomiting
Excess Alkali
Refeeding alkalosis
Hypercapnia
Diuretics

Front 9

Urine Cl <10-20, improves with saline, low serum Cl and volume

Three common causes?

Three causes of unresponsive Cl?

Tx for metabolic alkalosis?

Back 9

Cl responsive alkalosis

vomiting, diuretics, NG suction

endocrine - Bartter's, Cushings, Conns, severe K+ depletion, hyperaldo

NaCl, KCl, Mg, spironolactone for mineralocorticoid excess

Front 10

Causes of respiratory acidosis?

_____ pH, _____ PCO2, _____ HCO3-

Tx?

Back 10

anything that causes hypoventilation - CNS, drugs, CVA, pneumonia, pulm edema, PTX, COPD, restrictive disease

low pH, high PCO2, elevated HCO3

establish airway, suction, b-agonist tx, mechanical ventilation

Front 11

Causes of respiratory alkalosis? (CHAMPS)

raised lactic acid = ______ mortality.

Back 11

CNS
Hyperventilation
Anxiety
Mechanical ventilation
Progesterone
Salicylates/sepsis

raised mortality

Front 12

3 steps in ABG analysis?

Back 12

Step 1: check pH (<7.35 = acidosis, >7.45 = alkalosis)

Step 2: pCO2 and pH direction (same = metabolic, opposite = respiratory)

Step 3: actual to expected pH: pH change 0.08 for each 10 PCO2? if not, then metabolic component

Front 13

pH 7.58, PCO2 20:

pH 7.16, PCO2 70:

pH 7.5, PCO2 50:

Back 13

pure respiratory alkalosis (opposite direction, PCO2 change = 20, pH - .16)

pure respiratory acidosis (opposite direction, PCO2 change of 30, pH - .24)

metabolic alkalosis - pH, PCO2 same direction

Front 14

pH 7.25, PCO2 20:

pH 7.5, PCO2 20:

pH 6.8, PCO2 60:

Back 14

metabolic acidosis - pH PCo2 same direction

resp. alkalosis with metabolic acidosis - opposite direction, but pH lower than expected

resp and metabolic acidosis - opposite direction, pH is lower than expected