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| you donate a proton. a process of either an increase in POC2 (respiratory) or a decrease in HCO3- (metabolic). this tends to (but doesn't necessarily) drop pH - based on blood gas |
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| you accept a proton. a process of either a decrease in PCO2 (respiratory) or increase in HCO3- (metabolic). this tends to (but doesn't necessarily) raise the pH - based on blood gas |
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| what are the 3 rules for acid base analysis (order is specific)? |
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| 1) ignore the pH, read the pCO2 and HCO3-. 2) the pH 'points' to the primary process & a pH of 7.40 implies 2 primary processes (compensation is never complete) or a normal blood gas. 3) use the compensation formula of the primary process |
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| the acidosises and alkalosises |
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| total CO2: HCO3- mEq/L + pCO2 mmHG = HCO3- + (pCO2 x .03) (don't need to remember formula). the main point is that b/c .03 is so small, TCO2 can be used functionally as the bicarb, even though the actual bicarb will be a little higher |
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| what is the difference between volume contraction and dehydration? |
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| volume contraction is a loss of water and electrolytes concomittantly - one of the most common causes of metabolic alkalosis. (dehydration is a loss of just water) |
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| the difference between the plasma concentration of cations and anions, so anion gap = [Na+] - ([Cl]+[HCO3]). this uses the data from electrolytes (need to all to be from the same study) the normal range is 5 to 11 mEq/L. |
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| which out of the different acid-base disorders requires more work to diagnose? |
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| *metabolic acidosis* b/c it is graded on the anion gap, which can be high, normal or low (which no one ever talks about) |
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| what are the causes of an increased anion gap? |
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| mud piles; methanol, uremia, DKA, paraldehyde, intoxicants, lactate, ethylene glycol, salicates. |
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| what are the causes of a normal anion gap? |
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| hard up; hyperalimentaion, acetazolamide, RTA, diarrhea ureterosigmoid, pancreatic fistula |
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| what are the causes of a low anion gap? |
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| bmw; bromide toxicity, multiple myeloma, waldenstrom macroglobulinemia |
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| what is the trick in grading a metabolic acidosis? |
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| if you come up with a normal or decreased anion gap, you can dx & tx, but an increased anion gap can be hiding a normal anion gap or metabolic alkalosis - so do the delta-delta |
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| what is the delta-delta based on? |
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| elevation in the anion gap usually exceeds the fall in the plasma HCO3 concentration b/c >50% of buffering is done by the cell, not HCO3- |
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| (anion gap - 9)/(24-HCO3). where 9 = the normal anion gap (must be corrected for low albumin) and 24 equals the normal bicarb |
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| what are the 3 possibilities for delta-delta outcome? |
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| <1 (increased AG AND 'hiding' normal AG), 1-2 (increased AG only), and >2 (increased AG and 'hiding' metabolic alkalosis) |
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