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?

Decreases bicarbonate uptake Signup and view all the answers

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

Loss of sodium Signup and view all the answers

What is a primary cause of respiratory acidosis?

Increased carbon dioxide retention Signup and view all the answers

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

Medulla Signup and view all the answers

What is the formula used to calculate the anion gap?

[Sodium] - ([Chloride] + [Bicarbonate]) Signup and view all the answers

What does an anion gap greater than 12 indicate?

Increased anion gap metabolic acidosis Signup and view all the answers

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

Methanol Signup and view all the answers

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

Increased bicarbonate reabsorption 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?

Lactic acidosis Signup and view all the answers

What clinical result can occur due to methanol toxicity?

Blindness Signup and view all the answers

What hormone does the Zona Glomerulosa primarily secrete?

Aldosterone Signup and view all the answers

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

Hyperkalemia Signup and view all the answers

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

Hypokalemic, Hyperchloremic Metabolic Acidosis Signup and view all the answers

What is a characteristic hormonal dysfunction in Primary Adrenal Insufficiency?

Decreased cortisol secretion Signup and view all the answers

Which condition represents a cause of Secondary Adrenal Insufficiency?

Pituitary tumors Signup and view all the answers

How does Spironolactone primarily affect potassium levels?

Saves potassium in the body Signup and view all the answers

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

Increases chloride reabsorption Signup and view all the answers

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

Zona Reticularis Signup and view all the answers

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

Peripheral neuropathy Signup and view all the answers

Which acid is typically associated with ethylene glycol toxicity?

Glycolic acid Signup and view all the answers

What deficiency arises due to isoniazid toxicity affecting glutamate metabolism?

Pyridoxine (vitamin B6) Signup and view all the answers

Which of the following conditions can lead to lactic acidosis?

Hypoxia Signup and view all the answers

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

Metabolic acidosis + Respiratory alkalosis Signup and view all the answers

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

Increased conversion to lactic acid Signup and view all the answers

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

Oxalic acid Signup and view all the answers

What is a common intravenous fluid containing Propylene Glycol?

Dextrose 5% in water Signup and view all the answers

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.