Kidney Test 3

Front 1

what do you evaulate to determine the pathophysiology of acid/base changes?

Back 1

bicarbonate and arterial carbon dioxide

Front 2

in general do cellular reactions create acid or base?

how do we deal with the formation of that?

Back 2

acid

direct excretion or produce bicarbonate

Front 3

where is bicarbonate reabosrbed?

by what enzyme?

Back 3

PCT

carbonic anhydrase

Front 4

are free H+ excreted in urine?

Back 4

no the combine and from ammonium or phosphoric acid which gets secreted

Front 5

how dose ph adjustment vary when comparing renal and pulmonary?

Back 5

much faster pulmonary, by adjusting pulmonary rate

renal ajustment takes days

Front 6

what is normal pH?

normal hco3?

normal pco2?

Back 6

7.35-7.45

22-26

35-45

Front 7

where is blood for arterial blood gas testing taken from?

how does the bicarb from a chem 7 differ from the ABG test?

Back 7

-radial

it is 2-3 lower than abg

Front 8

what generally causes respiratory acidosis and alkalosis?

Back 8

distrubance in the arterial c02 concentration, results in metabolic compensation

Front 9

what exactly causes respiratory acidosis?

Back 9

respiratory insufficiency which results in increased arterial c02

Front 10

what exactly causes respiratory alkalosis?

Back 10

hyperventilation resulting in a decreased c02, results in decreased serum bicarb

Front 11

what genearlly cuases metabolic acidosis and alkalosis?

Back 11

disturbances in serum bicarb concentration

Front 12

how is metabolic acidosis corrected?

Back 12

increase in ventilation

Front 13

how do you correct metabolic alkalosis?

Back 13

loss of fluid that is low in bicarb or add bicarb, decreases in ventilation

Front 14

what is a simple acid base disorder?

what is mixed acid base disorder?

Back 14

a single isolated acid base disorder,there is only a single problem that is causing the issue

the simultaneous presence of more than one acid base disorder, could be many culprits contributing

Front 15

why are respiratory disorder considered acute or chronic?

why are metabolic acid base disorders always chronic?

Back 15

c02 is a rapidly volitle acide and can be rapidly changed by the the respiratory system, acid base issue can remain for minutes or days, making it chronic or acute

metabolic machinery that regulates in bicarb result in slow changes, and thus is considered chronic

Front 16

what is compensation?

Back 16

changes that follow the primary disorder and attempt to resotre the blood pH to normal

Front 17

what does the body do in chronic respiratory acidosis?

what does the body do in chronic respiratory alkoalosis?

Back 17

increase bicarb

decrease bicarb

Front 18

explain how acid base disorders are diagnosed?

Back 18

look at ph, then pco2, then hco3, assess compensation, calculate anion gap, caluclate excess gap

Front 19

serum is isoeletric but ions in the serum are not equal, why?

is there more cations or anions measured?

what is a healthy anion gap?

Back 19

only measuring certain eletolytes and negative proteins, phosphates and sulfates are not measured or other positive charges like mg or ca

cations (10-12) higher

10-12

Front 20

what does an anion cap greater than 12 suggest?

why is there an increase in anions

Back 20

accumulation of unmeasured anions which indicated metabloic acidosis

H will jump off acid and form co2 and water with while conjugate base will be left in blood with a neg charge, this represents a loss in bicarb which equals increasing acid

Front 21

define excess gap?

Back 21

amoount of bicarb that has been lost due to buffering unmeasured cations

Front 22

in general how should you treat acid base disorders?

Back 22

treat underlying cause and support the treatment of ph and electrolytes until underlying disease is improved

Front 23

what are the causes of anion gap metabolic acidosis?

Back 23

MUDPILES

methanol to formaldehyde then formic acid

uremia- renal failure accumation of po4 and so4

DKA

paraldehyde

isoniazid- treats TB

lactic acidosis

ethylene glycol

salicylate od

Front 24

what are the two types/causes of lactic acidosis?

Back 24

A- tissue hypoxia- hypotension, sepsis, anemia, shock

B- impared lactate clearance-liver disease, metformin, diabetes, cancer

Front 25

acid base disorders with the highst anion gaps are?

Back 25

ketoacidosis, lactic acidosis, methanol or ethylene glycol ingestion

Front 26

what is normal anion gap metabloic acidosis also called?

what is the most common cause?

Back 26

non-gap or hypercholermic because cl is very high

diarrhea- loss of bicarb, others included carbonic anyhdrase inhibitors or adrenal insufficency

Front 27

signs and symptoms of metabolic acidosis?

Back 27

hyperventilaiton, decrease cardiac function, lethargy

Front 28

how do you treat metabolic acidosis?

Back 28

iv sodium bicarb 1 meq/kg, for severe acidosis pH 7.1, or kidney failure

Front 29

why would you use sodium citrate over sodium bicarb?

Back 29

citrate is convereted to bicarb and does so with less na as compared to sodium bicarb

Front 30

what are the two types of metabolic alkalosis and how are they created?

Back 30

cl responsive- loss of chloride rich and bicarb poor fluid from diuretics or vomiting

cl nonresponsive- excess mineralocorticoid activity

Front 31

what two things need to be present for alkalosis to occur?

major symptom of alkalosis?

Back 31

concurrent loss of acid and impairment of renal bicarb excretion

hyperkalemia

Front 32

what can determine if your nacl responsive or non responsive?

Back 32

low urinary cl is responsive

high urinary cl is resistant

Front 33

how do you treat metabolic alkalosis?

what do you give a patient needs to take a diuretic or is nacl resistant?

Back 33

nacl if responsive

acetazolamide to maintain ph by inhibiting CA and holds on to H+

Front 34

what do you give for severe metabolic alkolosis?

what do you give to a patient if they have metabolic alkolsis from ng suction?

Back 34

0.1 HCL 100 ml/hr

h2 antagonists

Front 35

what is therapy for a nacl resistant metabolic alkolosis?

Back 35

decrease steriod dose or switch to less mineralcorticioid activity, adrenalectomy, or spirnolactone

Front 36

what is compensation for respiratory acidosis?

Back 36

kidneys increase bicarb production and h excretion

Front 37

how do you treat respiratory acidosis?

Back 37

provide adequate ventilation, 02, sodium bicarb

Front 38

how does compensation work for respiratory alkolosis?

Back 38

decrease bicarb reabosption in PCT

Front 39

signs and symptoms of respiratory alkolosis?

Back 39

lightheadedness, confusion, arrhythmia, n/v, decrease po4, k, ca

Front 40

treatment of respiratory alkoloiss?

Back 40

02 therapy, mechanical ventialtion

Front 41

when can you suspect mixed acid base disorder?

Back 41

normal ph with abnormal bicarb or pco2

Front 42

what would respiratory and metabolic acidosis look like?

what would cause it?

Back 42

very low ph

cardiorespiratory arrest, copd in shock, metabolic acidosis who develop respiratory failure

Front 43

what would respiratory alkalosis and metabolic alkoosis look like?

what would cause it?

Back 43

very high ph

hypotensive and on ventilator with vomiting and ng suctioning

Front 44

what would metabolic acidosis and respiratory alkalosis look like?

what causes it?

Back 44

normal ph, why you look at things beyond ph

liver disease, asa tox, pulmonary renal syndromes

Front 45

what would metabolic alkalosis and respiratory alkalosis look like?

what causes it?

Back 45

normal ph

copd treated with na restriction or diuretic