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Renal 05 Acid/Base

Ryan: Acid-Base Balance

What is normal pH? 7.36 to 7.44 (use 7.4 for calculations)
What is the equation for the buffer system in the body? [H]=24*Pco2/HCO3
What's going on in metabolic acidosis? Addition of acid or loss of bicarb from the body.
What's happening in metabolic alkalosis? Addition of bicarb or loss of acid from the body.
What's occurring in respiratory acidosis? Retention of CO2 by the lungs.
What's going on in respiratory alkalosis? Loss of CO2 by the lungs.
What are the criteria for acidosis/alkalosis and respiratory/metabolic? Metabolic = pCO2 <40, Respiratory = pCO2 >40 : Acidotic = pH <7.4, Alkolotic = pH >7.4
What is Winter's Formula and when do you use it? pCO2= 1.5*HCO3 + 8 +/- 2 : Used to determine the presence of a secondary acid-base disorder.
What are the relative changes with metabolic acidosis/alkalosis? pH, HCO3, and pCO2 all increase or decrease
What are the relative changes with respiratory acidosis/alkalosis? pH increases (decreases), HCO3 and pCO2 decrease (increase)
What is the serum anion-gap? The circulating serum cations must equal the anions; keeping the serum electrically neutral. : Anion gap is if there is a difference in the cations/anions
How do you measure the anion gap? AG= Na-Cl-HCO3
What is the predominate cause of an increases ion gap? Metabolic acidosis
What is the normal range for AG? Between 6 and 16
An increase in AG indicates what? Presence of unmeasured anions. Usually (but not always) associated with a fall in serum bicarb (metabolic acidosis)
Normal Anion Gap Metabolic Acidosis is also referred to as what? Hyperchloremic Metabolic Acidosis, since Cl increases to keep the AG normal.
What happens when you have a retention of acid with chloride as the anion? Increase in serum Cl and an unchanged AG
What happens when you have retention of an acid with non-chloride anions? Serum Cl will be unchanged and the AG will increase.
What is the delta/delta? ratio between the change in the anion gap and the change in the plasma HCO3 concentration.
What if the delta/delta is 1-2? Pure, high AG metabolic Acidosis
What if the delta/delta is <1? High AG acidosis + hyperchloremic metabolic acidosis
What if the delta/delta is >2? High AG acidosis + metabolic alkalosis
What does MUDPILES stand for? Methanol, Uremia, Diabetic KA, Paraldehyde, INH/Iron, Lactic Acidosis, Ethylene glycol, Salicylates
List some causes of Normal AG Metabolic Acidosis. GI loss of HCO3, Renal loss of HCO3, HCl/HCl precursor ingestion or infusion
What kind of things fall under GI loss of HCO3? Diarrhea and urterosigmoidoscopy (lose the duodenum, thus lose the ability to make HCO3)
What falls under Renal loss of HCO3? Distal renal tubular acidosis (type I), Proximal renal tubular acidosis (type II), Hyperkalemic renal acidosis (type IV)
What are the two categories for the causes of metabolic alkalosis? Low urinary chloride (<20 meq/L [Cl responsive]) and High urinary chloride (>20 meq/L [Cl unresponsive])
What things are considered low urinary chloride? Diuretics (remote), vomiting, GI suction, status post chronic hypercarbia
What falls under high urinary Cl? Diuretics (recent), High BP (primary hyperaldosteronism, Cushing's syndrome, Ectopic ACTH production), Low BP (Bartter's syndrome, Gitelman's syndrome, Sever K depletion)
What are the categorical causes of respiratory acidosis? CNS depression (not breathing off CO2) Neuromuscular disorders (can't inhale/exhale well) Thoracic cage restriction (can't take in deep breaths) impaired lung motion (not ventilating), acute obstructive pulmonary disease, chronic obstructive lung disease
What are the categorical causes of respiratory alkalosis? Anxiety, CNS disorders (blow off more CO2) Hormones, Drugs, Sepsis and endotoxemia, hyperthermia, hypoxia (can't ventilate) Pregnancy, cirrhosis, pulmonary edema, lung dz, pneumonia, ventilator induced
Deviations from the normal value of the serum AG reflects what? Either errors in the measurements of its constituents or in the concentrations of UC/UA
Increased anion gap... Decreased unmeasured cations (hypokalemia, calcemia, magnesemia)
Decreased anion gap... Increased UC (paraproteinemia, hypercalcemia, kalemeia) or Decreased UA (hypoalbuminemia, phosphatemia)
What is the effect of hypoalbuminemia? For each gram drop in serum albumin, the AG decreases by a factor of about 2.5
How do you measure the True AG when serum albumin is decreased? TrueAG=[(4.5-Serum Alb)*2.5]+AG
How do you calculate the Urinary Anion Gap? UAG= Na+K+Cl
What is the normal range for the UAG? -10 to 10
Cl in the urine is also a measure of what? NH4
If there was a loss of 10 meq of bicarb, how does the body respond? By excreting H as NH4 if it can. Seen as an increase in Cl; as Cl increases UAG becomes more negative.
What would happen to the UAG if there was a loss of HCO3 through the kidney? NH4 excretion is decreased, thus UAG becomes more +
What would happen to UAG if there was a loss of HCO3 through the GI tract? NH4 excretion is increase, and the UAG becomes more negative
What is the osmolar gap? The difference between the measured and calculated serum osmolality
How do you calculate the osmolar gap? OG= 2*[Pna]+[BUN]/2.8+[Glucose]/18
What does an OG >20 indicate? The presence of other osmolarly active substances in the blood.
Created by: bcriss