Podcast
Questions and Answers
What is the process that causes acid accumulation or alkali loss?
What is the process that causes acid accumulation or alkali loss?
What is the main buffer in the body?
What is the main buffer in the body?
What is the term for a serum pH below 7.35?
What is the term for a serum pH below 7.35?
What is the term for a process that primarily reduces bicarbonate?
What is the term for a process that primarily reduces bicarbonate?
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Which of the following can cause metabolic acidosis?
Which of the following can cause metabolic acidosis?
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What is the term for a process that primarily raises bicarbonate?
What is the term for a process that primarily raises bicarbonate?
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What is the reference range for the anion gap?
What is the reference range for the anion gap?
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What is the cause of an increased anion gap in patients with diabetic ketoacidosis?
What is the cause of an increased anion gap in patients with diabetic ketoacidosis?
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What is the primary purpose of calculating the anion gap in patients?
What is the primary purpose of calculating the anion gap in patients?
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Which of the following is NOT a cause of high anion gap acidosis?
Which of the following is NOT a cause of high anion gap acidosis?
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What is the result of buffering processes in respiratory alkalosis?
What is the result of buffering processes in respiratory alkalosis?
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Which of the following is a cause of normal anion gap acidosis?
Which of the following is a cause of normal anion gap acidosis?
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What is the primary cause of respiratory acidosis?
What is the primary cause of respiratory acidosis?
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What is a common accompanying condition in metabolic alkalosis?
What is a common accompanying condition in metabolic alkalosis?
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What is the normal pH range for respiratory alkalosis?
What is the normal pH range for respiratory alkalosis?
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Which of the following is a cause of respiratory acidosis?
Which of the following is a cause of respiratory acidosis?
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What is the effect of decreased ionized calcium levels on the body?
What is the effect of decreased ionized calcium levels on the body?
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What is the primary role of the kidneys in acid-base balance?
What is the primary role of the kidneys in acid-base balance?
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Study Notes
Acid-Base Disorders
- Acid-base disorders are pathologic changes in carbon dioxide partial pressure (Pco2) or serum bicarbonate (HCO3−) that typically produce abnormal arterial pH values.
Acidemia and Alkalemia
- Acidemia: serum pH < 7.35
- Alkalemia: serum pH > 7.45
Acidosis and Alkalosis
- Acidosis: physiologic processes that cause acid accumulation or alkali loss
- Alkalosis: physiologic processes that cause alkali accumulation or acid loss
Bicarbonate
- Bicarbonate is the main buffer
Definitions and Main Causes of Acid-Base Disorders
- Metabolic acidosis: process that primarily reduces bicarbonate
- Causes: excessive H+ formation, reduced H+ excretion, excessive HCO3- loss
- Metabolic alkalosis: process that primarily raises bicarbonate
- Causes: extracellular fluid volume loss, excessive potassium loss with subsequent hyperaldosteronism
- Respiratory acidosis: process that primarily causes elevation in PaCO2
- Causes: reduced effective ventilation
Common Causes of Metabolic Acidosis
- Diarrhea: excessive HCO3- loss
- Uremia: phosphoric, sulfuric, and lactic acids
- Diabetic ketoacidosis: increased ketones
- Strenuous exercise: lactic acid
- Methanol: formic acid
- Paraldehyde: β-Hydroxybutyric acid
- Isopropanol: propionic acid
- Ethylene glycol: glycolic acid, and some oxalic and formic acids
- Salicylate/aspirin: sulfasalicylic acid (SSA)
Anion Gap
- Anion gap is the difference between primary measured cations (sodium Na+ and potassium K+) and the primary measured anions (chloride Cl- and bicarbonate HCO3-) in serum
- Reference range: 16 ± 4 mEq/L (if the calculation employs potassium)
- Causes of anion gap acidosis:
- Normal anion gap: gastrointestinal losses of bicarbonate, renal tubular acidosis, treatment with carbonic anhydrase inhibitors, urinary diversion procedures
- High anion gap: renal failure, ketoacidosis, lactic acidosis, salicylate poisoning, glycol ingestion, excessive administration of 0.9% saline or propylene glycol, methanol ingestion
Respiratory Alkalosis
- Reduced carbon dioxide due to increased alveolar ventilation
- Buffering processes lower plasma bicarbonate concentration (rapid but limited response, ~1-2 meq/l)
- Kidney response: reduce net acid excretion (eliminate bicarbonate into the urine or decrease ammonium excretion)
- Compensation: kidneys control HCO3-
- Lab values: pH 7.35–7.45, increased CO2 35–45 mm Hg, decreased HCO3- 22–26 mmol/L
Respiratory Acidosis
- Respiratory acidosis is an accumulation of carbon dioxide in the body due to decreased excretion by the lungs
- Decreased carbon dioxide levels lead to pH imbalance
- Most common causes:
- Pulmonary disease (COPD, asthma, pneumonia, pulmonary edema)
- Respiratory failure Type 2
- Lab values: pH 7.35–7.45, decreased CO2 35–45 mm Hg, increased HCO3- 22–26 mmol/L
Metabolic Alkalosis
- Metabolic alkalosis is an accumulation of bicarbonate in the body caused by loss of stomach acid
- Excess bicarbonate leads to pH imbalance
- Usually accompanied by hypokalemia
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Description
This quiz covers the common causes of metabolic acidosis, including increased acid production, acid ingestion, and decreased renal acid excretion. It also explores the various metabolites associated with each cause, such as bicarbonate, ketones, and lactic acid. Test your knowledge of metabolic acidosis and its underlying mechanisms.
