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Renal - ABIM

Metabolic Acidosis / Acid Base

QuestionAnswer
Mnemonic for metabolic acidosis MUDPILERS - methanol (osm gap > 25); uremia; DKA/AKA/Starvation ketoacidosis; Paraldehyde / Propylene in lorazepam gtt; INH / Iron OD/ Infection; Lactic acid (meformin); Ethylene glycol (antifreeze, osm gap > 25); Rhabdo; Salicylate/ASA/NSAIDs
What is the characteristic acid-base pattern for salicylate poisoning? Anion gap metabolic acidosis with respiratory alkalosis due to hyperventilation
Mnemonic for non AG metabolic acidosis HARD IT UP - Hyperalimentation (TPN); Acetazolamide; RTA; Diarrhea; Isopropyl alcohol; Toluene; Uretero-sigmoid fistula (GI wasting HCO3-); Pancreatic fistula (pancreas secreting HCO3-)
Which ingestions have a smaller gap greater than 10? IMEEP - Isopropyl EtOH; Methanol; Ethylene glycol; Ethanol; Propylene glycol (lorazepam gtt)
What is the formula for calculation of serum osm? 2(Na) + gluc/18 + BUN/2.8
What is the formula for osm gap? measured - calculated. If >20, fomepizole. If > 50, then HD and fomepizole.
Formula for respiratory compensation in metabolic acidosis = 1.5 (HCO3-) + 8 +/- 2
Formula for respiratory compensation in metabolic alkalosis = 40 + (0.7) (24-HCO3-)
Formula for metabolic compensation in respiratory acidosis Acute: for every 10 increase in pCO2 --> 1 inc of HCO3- Chronic: for every 10 increase in pCO2 --> 3.5 inc of HCO3-
Formula for metabolic compensation in respiratory alkalosis Acute: for every 10 dec in pCO2 --> 2 dec of HCO3- Chronic: for every 10 dec in pCO2 --> 5 dec of HCO3-
Formula for anion gap = Na - (Cl+HCO3). Normal is 12 or lower.
Formula for gap gap corrected HCO3 = (AG - 12) + measured HCO3. If <22 then additional metabolic acidosis. If > 26 then additional metabolic alkalosis
What should you check before you calculate the gap gap? Check that albumin is normal. If albumin is low, for every 1 g decrease in albumin, increase the change in AG (the result of AG-12) by 2.5
Created by: christinapham