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Terms in this set (28)
Normal Serum Bicarb
Look @ pH to determine if primary disorder is
acidosis or alkalosis
look at pCO2 and the bicarb to determine if the disrder is primary
respiratory or metabolic
A High HC03 would indicate...
A high PCO2 would indicate
A low HCO3 would indicate
A low PCO2 would indicate
pH = pKa(6.10) + log([HCO3-]/(0.03*PCO2))
Winter's formula for resp comp:
PaCO2 = (1.5)*(HCO3-)+8
Compensation in a metabolic condition:
Will cause a respiratory compensation that causes the PCO2 to change in the
as the serum HCO3 to mitigate the change in pH
Compensation in a respiratory condition:
The renal compensation will cause the HCO3 to change in the
as the PCO2 to lessen the pH change
Will compensation return the arterial pH to normal?
No. A normal pH with an abnormal pCO@ and HCO3 indicates the
presence of a mixed disorder
How do we know if there is a mixed or single disorder?
If the change in HCO3 or PCO2 is less or more than would be expected as compensation then there is a mixed acid/base disorder present.
What is the respiratory compensation in Metabolic Acidosis?
decrease in HCO3, we will get a
decrease in PCO2
Winters Formula =
Arterial PCO2 = 1.5 x HC03 + 8 +/-2
*arterial PCO2 should be similar to the decimal digits of the arterial pH. For example, if the serum bicarb is 11 and the arterial pH is 7.25, the arterial pC02 should be 25.
Anion Gap =
measured cations - measured anions
Na - (Cl + HCO3)
What is the normal Anion Gap
What is the major unmeasured anion that makes up almost all of the gap?
What would cause a decrease in the Anion Gap?
Increase in unmeasured anions
What would cause an increased anion gap?
When the acid consists of
combined with another anion other than chloride, for example lactate (L)
- increased acid production
- Ingesting: salicylate, ethylene glycol, methanol
- decreased renal excretion of sulfate, phosphate, and urate in advanced renal failure
A normal anion gap acidosis occurs with the acid is what?
--> the bicarb is replaced on an equimolar basis by chloride, so there is no change in the anion gap. Also known as a
Causes of Non-Gap Acidosis
loss of bicarb or bicarb precursors
Type II RTA
Post Tx of diabetic ketoacidosis
Carbonic anhydrase inhibitors
Decreased Renal Acid Excretion
Type I RTA
Type IV RTA
Molder to moderate renal failure
Change in Anion Gap / Change in HCO3
The degree to which the anion gap rises in relation to the fall in bicarb varies with the cause of the acidosis.
What would cause a Delta Delta of 1:1
What would cause a Delta:Delta of <1
- Renal losses of anions in ketoacidosis, D-lactic acidosis, and toluene intoxication
- Chronic kidney disease when there is increased renal excretion of filtered anions, but hydorgen ion secretion is limited
- Mixed disorder: combination of a non-gap and a gap metabolic acidosis
Cause of a High Delta Delta
- If between
it can usually be from
due to larger space of distribution of hydrogen ions compared to lactate anions and limited lactate excretion in hypoperfusion induced lactic acidosis where there is limited or no renal function
- If between
it may signficy
mixed acid/base disorder
- Calculated osmolality
2Na + BUN/2.8 + Glucose/18
- Osmolal gap = measured - calculated
- Normal <10
- Increased osmolar gap with acidosis: ethylene glycol, methanol, ketoacidosis, renal failure
- Increased osmolar gap w/o acidosis: ethanol, isopropyl alcohol, TURP, and mannitol
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