Acidosis: Causes and Mechanisms
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Questions and Answers

What happens to chloride reabsorption when bicarbonate levels decrease?

  • Chloride reabsorption remains the same
  • Chloride reabsorption halts
  • Chloride reabsorption decreases
  • Chloride reabsorption increases (correct)

Which condition is most closely associated with hyperchloremic metabolic acidosis?

  • Dehydration
  • Excessive bicarbonate intake
  • Bicarbonate loss (correct)
  • Increased citrate levels

How does excessive total parenteral nutrition (TPN) affect bicarbonate levels?

  • It decreases chloride levels
  • It results in bicarbonate excretion (correct)
  • It increases bicarbonate levels
  • It has no impact on bicarbonate levels

What effect does acetazolamide have on bicarbonate in the body?

<p>Decreases bicarbonate uptake (D)</p> Signup and view all the answers

What is a common cause of normal anion gap metabolic acidosis, related to adrenal insufficiency?

<p>Loss of sodium (B)</p> Signup and view all the answers

What is a primary cause of respiratory acidosis?

<p>Increased carbon dioxide retention (B)</p> Signup and view all the answers

Which structure serves as the central chemoreceptor for carbon dioxide levels?

<p>Medulla (D)</p> Signup and view all the answers

What is the formula used to calculate the anion gap?

<p>[Sodium] - ([Chloride] + [Bicarbonate]) (D)</p> Signup and view all the answers

What does an anion gap greater than 12 indicate?

<p>Increased anion gap metabolic acidosis (C)</p> Signup and view all the answers

Which of the following is a cause of increased anion gap metabolic acidosis?

<p>Methanol (D)</p> Signup and view all the answers

How does the body physiologically respond to respiratory acidosis, in addition to increased CO2 expiration?

<p>Increased bicarbonate reabsorption (D)</p> Signup and view all the answers

Which of the following is NOT a component of the MUDPILES mnemonic for causes of increased AG metabolic acidosis?

<p>Lactic acidosis (B)</p> Signup and view all the answers

What clinical result can occur due to methanol toxicity?

<p>Blindness (B)</p> Signup and view all the answers

What hormone does the Zona Glomerulosa primarily secrete?

<p>Aldosterone (D)</p> Signup and view all the answers

Which electrolyte imbalance is most commonly associated with destruction of the Zona Glomerulosa?

<p>Hyperkalemia (C)</p> Signup and view all the answers

What is the end result of diarrhea in terms of metabolic status?

<p>Hypokalemic, Hyperchloremic Metabolic Acidosis (B)</p> Signup and view all the answers

What is a characteristic hormonal dysfunction in Primary Adrenal Insufficiency?

<p>Decreased cortisol secretion (B)</p> Signup and view all the answers

Which condition represents a cause of Secondary Adrenal Insufficiency?

<p>Pituitary tumors (D)</p> Signup and view all the answers

How does Spironolactone primarily affect potassium levels?

<p>Saves potassium in the body (B)</p> Signup and view all the answers

What effect does the loss of bicarbonate in diarrhea have on chloride levels?

<p>Increases chloride reabsorption (B)</p> Signup and view all the answers

Which adrenal zone is responsible for the secretion of secondary sex hormones?

<p>Zona Reticularis (D)</p> Signup and view all the answers

What is the clinical phenotype observed in isoniazid toxicity due to glutamate accumulation?

<p>Peripheral neuropathy (B)</p> Signup and view all the answers

Which acid is typically associated with ethylene glycol toxicity?

<p>Glycolic acid (C)</p> Signup and view all the answers

What deficiency arises due to isoniazid toxicity affecting glutamate metabolism?

<p>Pyridoxine (vitamin B6) (D)</p> Signup and view all the answers

Which of the following conditions can lead to lactic acidosis?

<p>Hypoxia (B)</p> Signup and view all the answers

Which acid-base disorder is CLASSICALLY caused by aspirin toxicity?

<p>Metabolic acidosis + Respiratory alkalosis (A)</p> Signup and view all the answers

In the context of isoniazid toxicity, what implication does the increase in glutamate have?

<p>Increased conversion to lactic acid (D)</p> Signup and view all the answers

Which of the following contributes to metabolic acidosis in the case of ethylene glycol poisoning?

<p>Oxalic acid (A)</p> Signup and view all the answers

What is a common intravenous fluid containing Propylene Glycol?

<p>Dextrose 5% in water (B)</p> Signup and view all the answers

Flashcards

Acidosis

A condition where the blood pH is below 7.30, often due to an accumulation of acids. There are 3 main causes: increased CO2, decreased bicarbonate, and increased inorganic acids.

Respiratory Acidosis

A type of acidosis caused by the retention of carbon dioxide (CO2) in the blood, leading to an increase in acidity.

Medulla

The area in the brainstem responsible for detecting high levels of CO2 in the blood, which triggers increased respiration to get rid of CO2.

Peripheral Chemoreceptors

Sensors in the aorta and carotid arteries that detect both high CO2 and low oxygen levels, sending signals to the brain to adjust breathing.

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Bicarbonate Reabsorption

The kidneys respond to acidosis by increasing the reabsorption of bicarbonate (HCO3-) from the urine back into the blood.

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Anion Gap (AG)

A blood test that helps determine whether acidosis is caused by pure loss of bicarbonate or the presence of extra acids. It is calculated using the formula: Sodium - (Chloride + Bicarbonate).

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Increased Anion Gap

Increased AG metabolic acidosis is caused by the presence of extra acids, in addition to bicarbonate loss. This can be remembered with the acronym MUD PILES.

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Diabetic Ketoacidosis (DKA)

A metabolic acidosis caused by the presence of excess ketone bodies in the blood, often seen in diabetic ketoacidosis (DKA).

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Inversely Proportional Relationship Between Bicarbonate and Chloride

A decrease in bicarbonate levels leads to an increase in chloride reabsorption in the kidneys, resulting in higher chloride levels in the blood.

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Main Cause of Normal Anion Gap (AG) Metabolic Acidosis

Normal AG metabolic acidosis is almost always caused by a direct loss of bicarbonate from the body.

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Hyperchloremic Metabolic Acidosis

A condition characterized by low blood pH due to a decrease in bicarbonate levels and a corresponding rise in chloride levels.

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Hyperalimentation (TPN) as a Cause of Metabolic Acidosis

Excessive TPN (Total Parenteral Nutrition) can lead to hyperchloremic metabolic acidosis due to the high chloride content of TPN solutions.

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Acetazolamide and Metabolic Acidosis

Acetazolamide, a carbonic anhydrase inhibitor, can cause metabolic acidosis by obstructing bicarbonate reabsorption in the kidneys.

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Beta-hydroxybutyrate

A ketone body produced during ketogenesis. It's used as an energy source in the absence of glucose.

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Acetoacetate

Another ketone body produced during ketogenesis. It is converted to acetone, thus contributing to the sweet, fruity breath odor.

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Acetone

A ketone body, produced from acetoacetate. It has a sweet, fruity smell and is detectable in patients with ketoacidosis.

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Ethylene Glycol

An alcohol commonly found in antifreeze, toxic when ingested.

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Glycolic Acid

A toxic compound produced by ethylene glycol metabolism. It causes metabolic acidosis and kidney stones.

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Oxalic Acid

A toxic compound produced by ethylene glycol metabolism. It causes calcium oxalate kidney stones.

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Lactic Acidosis

A type of metabolic acidosis caused by increased lactic acid in the blood. It can result from various conditions like hypoxia, sepsis, or drug toxicity.

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Isoniazid

A drug that can cause lactic acidosis and vitamin B6 deficiency.

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Primary Adrenal Insufficiency (Addison's disease)

A condition where the adrenal glands don't produce enough cortisol and aldosterone. This can be caused by infections, autoimmune disorders, or other factors.

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Zona Glomerulosa

The outermost layer of the adrenal cortex that produces aldosterone, a hormone that regulates sodium and potassium levels.

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Zona Fasciculata

The middle layer of the adrenal cortex that produces cortisol, a hormone involved in stress response and metabolism.

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Zona Reticularis

The innermost layer of the adrenal cortex that produces sex hormones, primarily androgens.

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Secondary Adrenal Insufficiency

A condition where the adrenal glands don't produce enough cortisol due to problems with the pituitary gland.

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Diarrheal Acidosis

A type of metabolic acidosis caused by the loss of bicarbonate and potassium through diarrhea, resulting in low potassium and increased chloride levels.

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Spironolactone

A medication that acts as an antagonist to aldosterone, promoting sodium excretion and potassium retention.

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Hyperkalemia

A medical condition marked by high potassium levels in the blood, often a symptom of adrenal insufficiency.

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Study Notes

General Causes of Acidosis

  • Acidosis occurs when blood pH falls below 7.30
  • Excessive carbon dioxide in the blood
  • Reduced bicarbonate levels
  • Increased presence of extra/inorganic acids

Respiratory Acidosis

  • Occurs from increased CO2 retention

  • Central chemoreceptors in the medulla respond to increased CO2, triggering increased expiration to reduce acidity

  • Peripheral chemoreceptors in the aorta and carotid arteries detect changes in CO2 and oxygen levels, sending signals to the central chemoreceptors

  • Physiological response to respiratory acidosis:

    • Increased bicarbonate reabsorption in the kidneys

Anion Gap

  • Anion gap (AG) helps determine the cause of acidosis
  • AG = [Na+] - ([Cl-] + [HCO3-])
  • Increased anion gap (AG > 12) suggests metabolic acidosis caused by extra/inorganic acids
  • Normal anion gap suggests metabolic acidosis caused by bicarbonate loss

Causes of Increased Anion Gap Metabolic Acidosis (MUDPILES)

  • Methanol
  • Uremia
  • Diabetic Ketoacidosis
  • Propylene glycol
  • Iron supplements, isoniazid
  • Lactic acid
  • Ethylene glycol
  • Salicylates

Additional Information

  • Bicarbonate and sodium reabsorption are coupled
  • Key clinical findings in various metabolic acidosis types are mentioned
  • Various extra acids that cause acidosis (e.g., formic acid, phosphoric acid, sulfuric acid, ketone bodies)

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Description

This quiz explores the fundamental causes of acidosis, including respiratory acidosis and the role of the anion gap. Delve into how increased CO2 retention and bicarbonate levels affect blood pH, along with identifying common metabolic acidosis causes using the MUDPILES acronym.

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