Therapeutics - Acid/Base 1

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Author:
kyleannkelsey
ID:
260887
Filename:
Therapeutics - Acid/Base 1
Updated:
2014-02-08 14:38:58
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Therapeutics Acid Base
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Therapeutics - Acid/Base 1
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Therapeutics - Acid/Base 1
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  1. Insulin
    Metabolic Acidosis/Diabetic Ketoacidosis
  2. Increase O2 delivery
    Metabolic acidosis: Lactic acidosis
  3. Sodium Bicarbonate IV
    • Metabolic acidosis
    • pH <7.1
    • Calc. deficit and give ½ deficit
    • Initial dose: 2-5 mEq/kg over 4-6 hours ( alternate dosing: 50 mEq bolus followed by 150 mEq in D5Q IV)
    • Stop after pH reaches 7.2
  4. Thromethamine (THAM)
    • Metabolic acidosis
    • IV treatment for FLUID OVERLOADED
    • Does not contain Na
    • Dose: 500mL
  5. Acetate or Lactate salts
    • Metabolic acidosis
    • Substitute for Chloride salts in TPN
  6. Dialysis
    Metabolic acidosis
  7. What are the oral Metabolic acidosis therapies?
    • Sodium Bicarbonate
    • Sodium Citrate
    • Potassium Citrate/Citric Acid
  8. Sodium Bicarbonate (oral)
    • Metabolic acidosis
    • Dose: 650-1300mg PO TID
    • OR
    • Dose: 12-14 tabs dissolved in 1-2L H20 taken over 1 hour
  9. Sodium Citrate
    • Metabolic acidosis
    • Oral
    • 10-30 mL in 30-90 mL H20
    • PC and HS
  10. Potassium citrate/Citric acid
    • Metabolic acidosis
    • Dose: 15-30 mL QID
    • PC and HS
  11. Anion gap equation
    AG = Na+ - ([Cl-]+[HC03-])
  12. What is the normal anion gap?
    10-12 mEq/L
  13. Acronym for Anion Gap potential causes:
    • MUD PILES:
    • Methanol
    • Uremia
    • Diabetic ketoacidosis/ starvation for EtOH ketoacidosis
    • Poisoning
    • Isoniazid/Intoxication/Infection
    • Lactic acidosis
    • Ethylene glycol/EtOH
    • Salicylates/Sepsis
  14. Acronym for Non-Anion gap potential causes:
    • Used Car
    • Ureteral diversion
    • Saline infusions
    • Exogenous acid
    • Diarrhea
    • Carbonic anhydrase inhibitors
    • Adrenal insufficiency
    • Renal tubular acidosis
  15. What type of pH imbalance is indicated by: pH <7.35 and pC02 <35?
    Metabolic acidosis
  16. What type of pH imbalance is indicated by: pH <7.35 and pC02 >45?
    Respiratory acidosis
  17. What type of pH imbalance is indicated by: pH >7.45 and pC02 <35?
    Respiratory alkalosis
  18. What type of pH imbalance is indicated by: pH >7.45 and pC02 >45?
    Metabolic alkalosis
  19. What is total C02?
    HC03- + C02
  20. Acronym for causes of Metabolic Alkalosis:
    • Clever PD:
    • Contraction (volume)
    • Licorice
    • Endo (Cushing’s)
    • Vomiting
    • Excess alkali
    • Refeeding alkalosis
    • Post-hypercapnia
    • Diuretics
  21. What causes of Metabolic Alkalosis are associated with high urine Cl-?
    • Refeeding alkalosis
    • Excess Alkali
    • Licorice
    • Cushing’s
  22. What are the treatment options for Metabolic alkylosis?
    • H2RA or PPI in pts w/↑upper GI fluid loss
    • Stop NG suction
    • Reduce dieresis
    • Substitute chloride salts for acetate or lactate salts in TPN
    • Acid replacement (if pH >7.6)
    • NS
    • Acetazolamide
    • Remove excess mineralcorticoid
    • Spironolactone
    • Replace Potassium deficit
  23. H2Ra or PPI
    Metabolic alkalosis treatment
  24. Stop NG suction
    Metabolic alkalosis treatment
  25. Reduce dieresis
    Metabolic alkalosis treatment
  26. Substitute chloride salts for acetate or lactate salts in TPN
    Metabolic alkalosis treatment
  27. Acid replacement
    • Metabolic alkalosis treatment
    • Use if pH >7.6
    • Calculate Cl- deficit and give ½ back IV as HCl in 12 hours
    • Stop at pH= 7.5
  28. NS
    • Metabolic alkalosis treatment – Saline Responsive
    • Urine Cl- < 10 mMol/L
    • Monitor: pH and urine Cl-

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