Acid Base Disorders

Table Of Contents
1 Metabolic Acidosis
2 Metabolic Alkalosis
3 Respiratory Acidosis
4 Respiratory Alkalosis
PresentationDx
NORMAL AG
(-) UAG 		Suggest EXTRA-Renal issues (i.e. gut):
– Diarrhea
– Fistula
– Ileal loop		NORMAL AG
(-) UAG

Equation: AG = [Na+] – ([Cl-] + [HCO3-]) = 12 +/- 2

Equation: UAG = Urine Na+ – Urine Cl-
Urine anion gap (UAG) measurement -distinguish between diarrhea and RTA as the cause of the normal anion gap metabolic acidosis
NORMAL AG
(+) UAG		Suggest Renal Issues:
– RTA
– Carbonic Anhydrase Inhibitor		NORMAL AG
(+) UAG
High Anion Gap (HAG)CAT MUDPILES

Carbon monoxide, Cyanide, Congenital
heart failure
Aminoglycosides
Teophylline, Toluene (Glue-sniffing)

Methanol
Uremia
Diabetic ketoacidosis, Alcoholic ketoacidosis, Starvation ketoacidosis
Paracetamol/Acetaminophen, Phenformin, Paraldehyde
Iron, Isoniazid, Inborn errors of metabolism
Lactic acidosis
Ethanol (due to lactic acidosis), Ethylene glycol
Salicylates/ASA/Aspirin		Equation: AG = [Na+] – ([Cl-] + [HCO3-]) = 12 +/- 2

Metabolic Acidosis

  • MOA:
    • increased acid, and hydrogen, decreased pH, and HCO3
  • Causes:
    • diabetes, diarrhea, starvation, protein breakdown
  • Treatment:
    • breathe more, kidneys reabsorb HCO3 or create more& excrete hydrogen in the urine

Metabolic Alkalosis

  • MOA:
    • decrease acid and H+, increase pH
  • Causes:
    • hypokalemia, vomiting, overdoes bicarb
  • Treatment:
    • breathe less, kidneys excrete bicarb in the urine

Respiratory Acidosis

  • MOA:
    • CO2 increases, H+ increases, pH decreases
  • Treatment:
    • breathe more, kidney could reabsorb bicarb

Respiratory Alkalosis

  • MOA:
    • hyperventilation, decrease CO2, H+ decrease, pH increase
  • Treatment:
    • breathe less, kidney’s secrete HCO3