Acid Base

Question 0

anion gap

Answer 0

Na- (HCO3 + Cl)

*adding acid consumes HCO3, therefore increasing anion gap

Question 1

three types of buffers

Answer 1

bicarb
phosphate (buffering causes bone loss)
proteins (mostly albumin–H displaces Ca and Na)

Question 2

factors that change the gap

Answer 2

increase- acid load

decrease- hypoalbuminemia

Question 3

acute compensation for respiratory acidosis

Answer 3

1 meq/L per 10 mmHg increase in PCO2

Question 4

chronic compensation in respiratory acidosis

Answer 4

3-4 meq/L per 10 mmg increase in PCO2

Question 5

respiratory compensation for metabolic acidosis

Answer 5

1.2 mmHg per 1 mEq/fall

Question 6

winter’s formula

Answer 6

calculates expected PCO2 (is compensation adequate?)

=(1.5*[HCO3-]+8) +/-2

Question 7

delta delta rule

Answer 7

if change in anion gap doesnt equal change in hco3, an additional acid-base disorder may be present

Question 8

hyperchloremic metabolic acidosis is either__ or __

Answer 8

retention of HCL or bicarb loss

Question 9

reasons for high anion gap metabolic acidiosis

Answer 9

MUD PILES
methanol
uremia
DKA
paraldehyde
INH
lactic acidosis
ethylene glycol
salicylate

Question 10

osmolar gap

Answer 10

measured posm-calculated posm

Question 11

calculated posm

Answer 11

2Na + glu/18 +BUN/2.8 + EtOH/4.6

Question 12

if osmolar gap is high

Answer 12

intoxication with unmeasured osmoles

Question 13

causes of increased osmole gap with acidosis

Answer 13

mud piles

Question 14

causes of increased osmolal gap without acidosis

Answer 14

DELLPIM
diethyl ether
ethanol
lipidemia
lithium toxicity
proteinemia
isopropanolol
mannitol

Question 15

change in anion gap greater than change in bicarb

Answer 15

metabolic alkalosis present

Question 16

change in anion gap less than change in bicarb

Answer 16

hypercholermic metabolic acidosis present

Question 17

renal tubular acidosis presents as

Answer 17

hypercholermic acidosis

Question 18

distal RTA

Answer 18

inability to excrete H+

Question 19

proximal RTA

Answer 19

inability to reabsorb HCO3

Question 20

urine anion gap

Answer 20

(Na+K)-Cl

Question 21

kidney excretes acid as

Answer 21

NH4Cl

Question 22

negative urine ion gap

Answer 22

expected in metabolic acidosis with healthy kidney

Question 23

positive urine anion gap

Answer 23

distal RTA

Question 24

TYPE 1 RTA

Answer 24

impaired H+ secretion in DISTAL tubulue

Question 25

type 1 urine pH

Answer 25

>5.5

Question 26

causes of RTA 1

Answer 26

idiopathic drugs- isofamide, amphoB, Lithium hypercalciuria (damages distal nephron) obstructive uropathy

Question 27

RTA 1 labs

Answer 27

low urine pH positive UAG hypokalemia

Question 28

type 2 RTA

Answer 28

cant reabsorb HCO3-

Question 29

acidosis in RTA 2

Answer 29

less severe

Question 30

labs in type 2 RTA

Answer 30

>5.5 pH UAG - bicarb stays 12-18 because hits tmax hypokalemia

Question 31

how to distinguish rta 2 from diarrhea

Answer 31

load with bicarb- shoudl immediately cause bicarburia

Question 32

tx or rta 2

Answer 32

lots of bicard

Question 33

type 4 RTA

Answer 33

hypercholremic acidosis with hyperkalemia | decreased aldosterone effect

Question 34

causes of type IV RTA

Answer 34

``` decreased aldo production aldo ressitance (ENAC blocked by K sparring diuretics, bactrim, pseudo hypoaldo because decreased distal Na low) defects in Enac ```

Question 35

labs type 4 RTA

Answer 35

low bicarb pH>5.5 in urine hyperkalemia (should be suspected when hyperkalemic but no increased effort to excrete (urine K is normal))

Question 36

drug for hypoaldosteronism

Answer 36

fludocortisones

Question 37

acute metabolic comp for resp alkalosis

Answer 37

-2 mEq/L per -10 mmHg

Question 38

chronic respiratory alkalosis compensation

Answer 38

-4 per -10

Question 39

what makes you immediately thing salicylate toxicity

Answer 39

respiratory alkalosis with elevated AG acidosis

Question 40

mechanism of salicylate toxicity

Answer 40

hyperventilation because of salicylate acid-->rep alklaosis also direct stim of resp center-->further hypervent-->lots of resp alklaosis

Question 41

compensation for metabolic alkalosis

Answer 41

+0.7 mmHg per 1 mEq/L

Question 42

contraction alkalosis

Answer 42

volume depeletion with Cl-containing fluid will stimulate an increase in Na reabs (via aldo)..since Cl- isnt pressent HCO3 will go with it

Question 43

milk-alkali syndrome

Answer 43

ingestion of HCO3 or CO3 alone is not enough to make alklaosis, but if you do it with calcium (tums, dairy, etc) you will inhibit distal HCO3 excretion

Question 44

tx metabolic acidosis

Answer 44

remove offending agent or block affected channels