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46 Cards in this Set
- Front
- Back
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What is the primary buffer system in the body?
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Bicarb
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What causes metabolic acidemia (general mechanism)
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Addition of acid or loss of Bicarb
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What causes metabolic alkalemia (general mechanism)
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Addition of bicarb or loss of acid
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What causes Respiratory acidemia (general mechanism)
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retention of Co2
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what causes respiratory alkalemia?
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Loss of Co2
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If the Pco2 is greater than 40 but the Ph is less than 7.4 you have _____.
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respiratory acidosis (low PH, high CO2)
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If the Pco2 is less than 40 and the Ph is less than 7.4 you have _____.
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Metabolic acidosis (low Ph, Okay Co2= loss of bicarb)
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If the pco2 is greater than 40 and the Ph is greater than 7.4 you have_____.
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metabolic alkalosis
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If the Pco2 is less than 40 and the ph is greater than 7.4 you have _______.
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Respiratory alkalosis
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What is the primary acid base disorder? PH= 7.3, Pco2= 30.
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metabolic acidosis
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What is the primary acid base disorder? PH= 7.2 Pco2= 25
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metabolic acidosis
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What is the primary acid-base disorder? PH= 7.32, PCO2=37
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metabolic acidosis
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What is the primary acid-base disorder? PH=7.45, PCO2= 47
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Metabolic alkalosis
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What is the primary acid-base disorder? PH= 7.43, PCO2= 45
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Metabolic alkalosis
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What is the primary acid-base disorder? PH= 7.44, PCO2= 50
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Metabolic alkalosis
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What is the response to metabolic acidosis?
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Loss of Pco2
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what is the response to metabolic alkalosis?
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retention of PCO2
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What is winter's formula?
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Pco2= 1.5 HCO3 + 8 (deviation of 2)
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what is the primary acid-base disorder?What is the secondary disorder? PH= 7.26, PCO2= 26, HCO3=12
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Metabolic acidosis, NONE
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what is the primary acid-base disorder? what is the secondary disorder? PH= 7.26, PCO2=35, HCO3=14
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metabolic acidosis
(PCO2= 1.5 (14) +8=29) winter's formula Because 35 does not equal 29, the secondary disorder is acidosis (high CO2= high acid) |
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What is the primary acid-base disorder? what is the secondary disorder? PH= 7.32, PCO2=30, HCO3=18.
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Metabolic acidosis (ph low, Pco2 low)
Winters formula; 1.5*18 +8= 35 Because 30 does not equal 35, there is an alkalosis (not enough acid) |
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When do we evaluate anion gap?
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metabolic acidosis
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What ions make up the cations? anions?
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Sodium
Chloride/bicarb |
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What is the anion gap equation?
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NA - (CL +HCO3)= Anion gap
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what is the primary cause of an increased anion gap?
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decreased HCO3= metabolic acidosis
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what does an increased anion gap represent?
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presence of other unmeasured anions
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If you add 10 Meq of lactate what will happen to bicarb? what will happen to the anion gap? (Na= 140,chloride=104, bicarb=24)
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Bicarb will decrease from 24 to 14 (1:1 with lactate) that makes the anion gap increase from 12 to 22.
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what happens in metabolic acidosis with a retention of chloride?
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increase in serum chloride and unchanged anion gap.
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What happens in metabolic acidosis with a retention of lactate or aceto acetate?
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unchanged serum chloride and increase in the anion gap
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What is the delta ratio?
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the ratio between the anion gap and the HC03 concentration
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What does it mean if the delta ratio is 1-2?
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Pure High AG metabolic acidosis
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what happens if the ratio is <1 (delta)?
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high AG acidosis and hypercholemic metabolic acidosis
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If the ratio >2 (delta)?
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high AG acidosis + metabolic alkalosis
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what are the causes of high AG metabolic acidosis?
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MUDPILES
Methanol Uremia DKA Paraldehyde INH Lactic Acidosis Ethylene glycol Salicylates |
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What are the causes of normal AG metabolic acidosis?
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GI loss of HCO3
Renal loss of HCO3 HCL/HCL precursor or ingestion |
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What are the three ways to loss HCO3 renally?
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Distal renal tubular acidosis
proximal renal tubular acidosis hyperkalemic renal acidosis |
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What are the "chloride responsive" causes of metabolic alkalosis?
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Past diuretics, vomitting, GI suction, Hypercarbia
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Why would you add chloride to a metabolic alkalosis? At what level of urinary chloride is it unresponsive?
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>20MEQ/L
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What are the causes of respiratory acidosis?
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CNS depression, Neuromuscular disorders, Thoracic cage restriction,impaired lung motion, Acute obstructive pulmonary disease,
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What results in an increased anion gap?
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decreased unmeasured cations (UA- a decreased UC= increased serum anion gap. Hypokalemia, hypocalcemia, hypomagnesemia
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What results in a decreased anion gap?`
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Increased unmeasured cations, or decreased unmeasured anions.
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what is the effect for hypoabluminemia?
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Hypoalbuminemia reduces the unmeasured anions and causes a decreased anion gap.
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What are the urinary cations?
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measured: sodium and potassium
Unmeasured: ammonium, calcium, magnesium |
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What are the urinary anions?
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Measured: chloride
Unmreasured: Bicarb, phosphates, sulhates, hippurate |
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what is the urinary anion gap equation?
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Sodium + potassium - chloride = UA - UC
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What is the relationship between urinary chloride excretion and ammonium?
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As ammonium increases, chloride increases as well. ( i.e. they balance themselves out)
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