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Acid-Base ck

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isolis's version from 2016-07-27 19:57

Section

Question Answer
• Causes of respiratory acidosis (name 3 or 4)COPD/asthma, drugs (opiods, benzos, etc things that are respiratory depressants), chest wall issues so you breathe less, sleep apnea
• Causes of metabolic acidosis?MUDPILES (methanol, uremia, DKA, propylene glycol, Infection/iron/isoniazis, Lactic acidosis, Ethylene glycol, Salicylates, plus diarrhea and carbanic anhydrase inhibitors
• Causes of respiratory alkalosisanxiety/hyperventilating and aspirin overdose
• Causes of metabolic alkalosisdiuretics (except carbonic anhydrase inhibitors), vomiting, antacid abuse/milk alkali, hyperaldo, volume contraction
• Symptoms of aspirin overdose? What kind of acid base disturbance does it cause?vomiting, tinnitus, hypoglycemia, causes respiratory alkalosis and metabolic acidosis (two primary disturbances)
• Asthmatic is in asthma attack, and his acid base status changes from alkalotic to normal, patient is now sleeping, what should you think?crashing! Normally alkalotic b/c they're eliminating CO2 during asthma attack, but when they get too tired to breathe, they'll retain and pH will normalize. Prepare for intubation and continue aggressive treatment with B2 agonists, steroids, oxygen!
• Three different types of hyponatremiaHypovolemic, euvolemic, hypervolemic
• Causes of hypovolemic hyponatremia?dehydration, diruetics, addison's disease, hypoaldo
• Causes of euvolemic hyponatremia?SIADH, psychogenic polydipsia,
• Causes of hypervolemic hyponatremiaCHF, nephrotic syndrome, cirrhosis, renal failure
• Treatment for hypovolemic hyponatremia? Euvolemic? Hypervolemic?Normal saline, fluid restriction, or diuretics maybe for hypervolemic
• Treatment of SIADH if water restriction fails?Demeclocycline, causes nephrogenic DI basically
• These three conditions can cause "false" hyponatremiahyperglycemia, hyperlipidemia, hyperproteinemia, do not give patient saline or extra salt
• What causes hyponatremia in postop patients?narcotics (causing SIADH) and overaggressive IV fluids. Rare cause might be adrenal insufficiency where you would see high potassium and low blood pressure
• Hyponatremia in pregnant patients about to deliver?oxytocin has ADH like effect
• Treatment for HYPERnatremia?usually just normal saline then switched to 1/2 NS when patient is hemodynamically stable
• Why is bicarb given to severely hyperkalemic patients?b/c of cellular shift. A lot of K goes in and a lot of H goes out, making patient acidotic
• Hypokalemia persisting even after a ton of K given, what do you think?check magnesium level
• Asymptomatic patient's test shows hyperkalemia, what do you think of?take another specimen, b/c the one you got may have hemolyzed and hemolysis increases K
• If K is high, but less than 6.5, what do you do to treat? But what if it's greater than 6.5 or cardiac toxicity is apparent on EKG?restrict K intake and give sodium polysterene resin (kayexalate). Otherwise, give calcium gluconate, sodium bicarb to shift K into cells, and glucose with insulin to shift K into cells but glucose too so they don't get hypoglycemic. Another option is B2 agonists (eg albuterol, salbutamol, terbutaline). If patient has renal failure, dialysis
• Sx of hypocalcemiatetany - chvostek and trousseau sign, QT interval prolongation too, seizures possible
• First step when you see hypocalcemia?check albumin and protein levels to see if that's low because that can cause hypocalcemia. For every 1 g/dL decrease in albumin below 4, correct calcium by adding 0.8 mg/dL
• Short fingers, short stature, mental retardation, normal levels of PTH but hypocalcemic?Albright's hereditary osteodystrophy: pseudohypoparathyroidism - unresponsive to PTH
• Relationship between low calcium and low magnesium?need to correct magnesium before calcium will correct
• pH effect on calcium levels?alkalosis causes Ca to shift into cells and causes hypocalcemia
• Sx of hypercalcemia if symptomatic?Bones (osteopenia), Stones (kidney stones), Groans (abd pain), Psych overtones, also QT interval shortening
• Sign of familial hypocalciuric hypercalcemia?low urinary calcium but hypercalcemia
• Treatment of hypercalcemia? Why do you treat?fluids and loop diuretics (NOT thiazides). Treat b/c reduce risk of kidney stones. Can also give bisphosphonates or oral phosphorus or prednisone (for malignancy induced hypercalcemia). Basically treat the underlying cause
• When do you see hypermagnesemia clinically?patients treated for pre-eclampsia with mag sulfate or patients with renal failure
• Signs of hypermagnesemia? Risks?initial sign is decreased DTR and then hypotension and respiratory failure
• Treatment hypernatremia?Normal saline then switch to 1/2 NS when hemodynamically stable
• Alkalosis esffect on albumin and therefore calcium?hydrogen dissociates from albumin, so free calcium binds to albumin and therefore the physiologically active form is decreased and you get crampy and shit
• Treatment for hypercalcemia related to granulomatous disease?steroids, reduce calcitriol release from activated mononuclear cells
• Treatment for metabolic alkalosis?underlying cause and normal saline infusion to promote bicarb excretion
• Acidosis following tonic clonic seizure?postictal lactic acidosis, transient, it'll resolve without treatment
• Treatment for symptomatic hypercalcemia?IV normal saline, promotes urinary calcium excretion
• Korsakoff syndrome thought to be due to damage tomammillary bodies and thalamic nuclei
• These drugs have a similar hangover effect as disulfirammetronidazole and some cephalosporins
• Alcoholic with pneumonia, with "mucoid capsules" or "currant jelly"kelbsiella
• How do you treat actively bleeding varices? What about varices with no history of bleeding?actively bleeding - cauterize/band, vasopressin. Otherwise, nonselecitve beta blockers to relieve portal hypertension (propranaolol, nadolol, timolol)
• Vision loss and coma with optic disc hyperemia in a homeless guy?methanol poisoning
Methanol damages the eyes, ethylene glycol damages the _________kidneys
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