step II

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step II
2010-06-18 00:24:41
acid base

HY facts
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  1. Respiratory Acidosis
    PCO2 >44
  2. Respiratory Alkalosis
    PCO2 <33
  3. Metabolic Acidosis
    Bicard <22
  4. Metabolic Alkalosis
    Bicarb >28
  5. What acid/base disorder does Thiazide diuretics cause?
    • Metabolic Alkalosis - increased bicarb
    • blocks Na/Cl transporter in distal tubule but increase Na concentration in tubule which stimulates the aldosterone-sensitive Na pump increasing Na reabsorption in exchange for K& H into the urine and reclaimed bicarb into serum.
  6. What acid/base disorder does persistent vomiting cause?
    • Metabolic Alkalosis, increased bicarb
    • -lose acid, increased bicarb in blood excess filtered by kidney
    • -volume depletion, decreased peritubular hydrostatic pressure causes renal threshold for bicarb to inrease b/c holding onto Na causes H secretion and brings in more bicarb
  7. What acid/base disorder does NG tube cause?
    • Metabolic alkalosis - increased bicarb
    • -loosing acid and volume depleted so holding onto Na at expense of wasting H and thus resorption of bicarb in kidney
  8. What acid/base disorder does diarrhea cause?
    • Non gap Metabolic acidosis (decreased bicarb)
    • hyperchloremic: remember for every bicarb lost body holds onto a chloride to balance charges
  9. What acid/base disorder does amphotericin cause?
    • Non Gap Metabolic Acidosis (decreased bicarb)
    • Type I Renal tubular acidosis - destroys H/K pump in distal tubule. Cant get rid of H ions
    • also loose Calcium due to pump dysfunction
    • urine pH >5.5, muscle weakness (hypocalemic)
  10. What acid/base disorder does aminoglycosides cause?
    • Non Gap metabolic acidosis (decreased bicarb)
    • type II renal tubular acidosis - destroys proximal tubule
    • decreased bicarb threshold in kidney, eventually serum level and threshold stabalize
    • urine pH>5.5 (alkaline)
  11. What acid/base disorder does COPD cause?
    Respiratory Acidosis - trouble getting air out...retain CO2
  12. What acid/base disorder does Guillan Barre cause?
    Respiratory Acidosis - depressed respirations due to diaphragm paralysis and retain CO2
  13. What acid/base disorder does Obstructive sleep apnea cause?
    respiratory acidosis - retain CO2
  14. What acid/base disorder does Cystic fibrosis cause?
    • respiratory acidosis
    • increased pCO2
  15. What acid/base disorder does salicylate intoxication cause?
    • Respiratory Alkalosis
    • over stimulates respiratory center in medulla - low pCO2
  16. What acid/base disorder does Endotoxins cause?
    • from gram neg bacteria infections
    • respiratory alkalosis - oversitmulates respiratory center in medulla
    • decreased pCO2
  17. What acid/base disorder does Cirrhosis cause?
    • Respiratory Alkalosis
    • increased toxins stimulate respiratory center in medulla
    • decreased pCO2
  18. What acid/base disorder does bronchial asthma cause?
    • respiratory alkalosis, decreased pCO2
    • exception to rule that obstructive lung diseases cause resp acidosis b/c they hyperventilate due to feeling that they can't breath. If they are acidotic intubate b/c it means they are running out of energy to keep breathing
  19. What acid/base disorder does pulmonary embolus cause?
    respiratory alkalosis - tachypnea causes decreased CO2
  20. What acid/base disorder does sarcoidosis cause?
    • respiratory alkalosis, decreased pCO2
    • restrictive lung disease...can't get air in ... take small rapid breaths
  21. What acid/base disorder does CNS injury cause?
    respiratory depression ...respiratory acidosis (increased pCO2)
  22. Causes of increased A-a gradient?
    • 1. Ventilation defect - atelectasis (airway collapsed)
    • 2. Perfusion defect - Pulmonary embolis
    • 3. Diffusion defect - interface altered - fibrosis/ pulmonary fluid. RHF, Pneumonia...
  23. What acid/base disorder does spirinolactone cause?
    • Aldosterone blocker (others include triamterene or amiloride)
    • metabolic acidosis
    • decreased bicarb <22
  24. What acid/base disorder does hypoxia cause?
    • Hypoxia leads to anaerobic glycolysis and lactic acid formation
    • Anion gap metabolic acidosis
  25. Causes of Anion Gap Metabolic Acidosis?
    • M - Methanol
    • U - Uremia
    • D - Diabetic Ketoacidosis (also alcohol ketosis, starvation ketosis)
    • P - Para-aldehyde
    • I - Isoniazid, Iron, Inborn Errors of Metabolism
    • L - Lactic Acid
    • E - Ethylene Glycol
    • S - Salicylates
  26. Calcium oxylate crystals are associated with what acid/base disorder?
    • Anion Gap Metabolic Acidosis
    • Ethylene Glycol
  27. What acid/base disorder is associated with smoking?
    • Respiratory acidosis
    • increased pCO2