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21 Cards in this Set
- Front
- Back
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What is the equation for the anion gap?
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(Na+ + K+) - (Cl- + HCO3-)= unmeasured anions
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Why do we only care about the unmeasured anions (i.e. what about the cations)?
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Mg2+ and Ca2+ don't change very much
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A hypo______ state alters the anion gap.
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Hypoalbumenemic - useful when looking at metabolic acidosis to try and get more information as to the source
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If there's a normal anion gap in a patient that has metabolic acidosis, what anion has probably increased to maintain a normal anion gap?
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Metabolic acidosis means have lost too much bicarbonate, so that means chloride must have increased
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In general, what comes to mind when lactate is mentioned?
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Think anaerobic metabolism, when think anaerobic metabolism think inadequate tissue perfusion
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You have a goat that has been trying to kid for 12-18 hours and had been off feed for several days. It has a normal lactate level, a pH of 6.5 and bicarbonate is extremely low. Where do you think the base excess is coming from?
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Pregnancy toxemia & ketoacidosis
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Why is base excess helpful over the anion gap sometimes?
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Because sometimes the hyperchloremia can create a normal anion gap, but the base excess will be abnormal- can elude to the problem like with above example where ketone bodies were causing the acidemia, this wouldn't be detected with an anion gap
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Why would bicarbonate be so low in the goat that's been trying to kid for 12-18 hours and has been off of feed for a couple days?
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Bc the bicarbonate is being consumed trying to buffer the ketone bodies
-H+ + HCO3- <------> H2CO3 -get acidemia when this is overwhelmed |
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What should you do for a ruminant that gets down to a bicarbonate level of about 19 mEq/L?
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Just need to give fluids******* if not giving bicarbonate, perfuse the system and let it correct itself
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When should you add bicarbonate to your fluids?
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Below 16-18 mEq/L= trigger point
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What is the trigger point for pH?
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pH <7.2
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What is the firs thing you need to ask yourself when trying to decide if you should add bicarbonate to fluids for an animal with a pH of 7.2? Why?
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Is this respiratory or metabolic issue?
-if respiratory acidosis then if add bicarbonate it will only make things worse bc its a respiratory problem and so you can't get rid of CO2 so you just increasing CO2 in a system that is already overwhelmed, need to put on ventilator -*why you identify the primary disturbance |
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What is the alveolar arterial difference?
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The gradient that we normally expect from the alveolar side to the arterial side in the lungs.
-Gradient from air that's breathed in through nose/mouth that goes down to lungs to alveoli then goes across the membrane to artery |
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How can you tell if there's diffusion impairment in the lungs?
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If the alveolar arterial difference is greater than 25-30 mmHg (normal= 5-10) = lung disease= hypoxemia
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How can you tell if the PaO2 is normal for the amount of oxygen in the air?
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Can take 5 x FiO2 and find what level PaO2 should be at
-room air= 21% oxygen= 5 x 21= ~100 |
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What should the PaO2 be if you are giving a patient 40% oxygen?
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5 x 40= ~200, so if get to 190 on 40% oxygen= doing pretty good, if were to only be at 100 then not doing very good
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What is the rule of 120?
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-When add PaO2 + PaCO2 it should equal ~140 (140 +/- 10-20) because normal PaO2= 100, PaCO2= 40= 140 = normal functioning animal
-When have PaO2= 60 and PaCO2= 60=120= poor functioning lungs bc have mixture of venous blood |
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With metabolic acidosis bicarbonate drops, so there should be a change in what in response to that lowering bicarbonate?
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Should see a drop in CO2- there are exact amounts
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How can you tell if the primary problem is respiratory or metabolic based off the PaCO2 and bicarbonate levels, when the pH is NORMAL?
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Calculate what the shift should be if metabolic and see if CO2 change correlates, then calculate what the change should be if the issue was respiratory and see if bicarbonate level match
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What does it mean if the numbers don't add up for the primary acid/base disturbance being metabolic or respiratory when the pH is normal?
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Then must have a mixed acid/base problem because the body NEVER OVERCOMPENSATES (can have +/-2 from calculation & be normal)
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Why don't the calculations for shifts in carbonate to CO2 (with normal pH) vary for chronic vs acute for metabolic disorders?
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Respiratory responds immediately, if respiratory issue it takes kidneys several days to compensate
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