diabetestalk.net

Acidosis And Alkalosis Mnemonic

Metabolic Muddle Litfl Clinical Cases Catmudpiles

Metabolic Muddle Litfl Clinical Cases Catmudpiles

The first step: is the patient acidaemic or alkalaemic? The second step: is there a metabolic acidosis or a respiratory acidosis or both? The third step: is there appropriate compensation? The estimated expected CO2 is 1.5xHCO3 + 8 i.e. approximately 13 so its pretty close The fourth step: what is the nature of the metabolic acidosis? The anion gap is markedly elevated at 35 [(Na+ K+) (Cl-+HCO3-)] The fifth step: is there a coexistent normal anion gap acidosis or pre-existing metabolic alkalosis? If the high anion gap acidosis is the only metabolic disturbance, the bicarbonate drops by the same degree that the anion gap rises. In this case, assuming a normal anion gap of 12, the anion gap has increased by 23 while the HCO3- has decreased by 23.Assuming a normal HCO3- of 26 the bicarbonate has decreased by 23 to finish up at 3. So the high anion gap metabolic acidosis is the only metabolic disturbance. If the bicarbonate drops less than anticipated, it must have started off at a higher level than you normally expect (i.e. there must be a pre-existing metabolic alkalosis) If the bicarbonate drops more than anticipated, there must be another source of acidosis (i.e. a co-existent normal anion gap acidosis) Continue reading >>

Acid-base Differential Diagnosis

Acid-base Differential Diagnosis

This patient's elevated blood pH and decrease in PaCO2 is consistent with acute respiratory alkalosis. Respiratory acid-base disorders are caused by primary changes in PaCO2, whereas metabolic acid-base disorders are due to primary changes in the concentration of HCO3-. A primary rise in PaCO2 or a fall in plasma HCO3- reduces the pH (acidemia), whereas the opposite increase the pH (alkalemia). Patients suffering from pneumonia can have tachypnea due to hypoxia. Increased minute ventilation reduces arterial CO2, an acid, resulting in alkalosis. A slight decrease in bicarbonate level may be seen due to early renal compensation. Answer 1: Normal pH range is 7.35-7.45. This patient's pH is outside this range, which indicates an acid-base disturbance. Answer 2: A decreased pH and an decrease in HCO3- would be consistent with metabolic acidosis. Answer 3: An elevated pH and an increase in HCO3- would be consistent with metabolic alkalosis. Answer 4: Respiratory acidosis results from decreased alveolar ventilation, which causes increased arterial CO2 levels. Continue reading >>

Acidosis | 5-minute Emergency Consult

Acidosis | 5-minute Emergency Consult

Type your tag names separated by a space and hit enter Reduced pH owing to alveolar hypoventilation with elevated PaCO2 Defined as PaCO2 >45 mm Hg or higher than expected for calculated respiratory compensation for metabolic acidosis Primary failure in CNS drive to ventilate: Primary failure in transport of CO2 from alveolar space: Primary failure in transport of CO2 from tissue to alveoli: Process that reduces serum pH by decreasing plasma bicarbonate levels Accumulation of a strong acid through ingestion or metabolism Metabolic acidosis is clinically evaluated by dividing into 2 main groups: Bicarbonate reduced through buffering of added strong acid Anion gap is increased due to retention of the unmeasured anion from the titrated strong acid. Normal anion gap metabolic acidosis due to: Kidneys fail to reabsorb or regenerate bicarbonate. Losses of bicarbonate from GI tract (diarrhea) Ingestion or infusion of substances that release hydrochloric acid No anion gap is observed owing to the absence of any unmeasured anion of a titrated acid and secondary chloride retention with HCO3 loss. Anion gap acidosis: Mnemonic A CAT PILES MUD: Removal of small bowel, pancreatic or biliary secretions Anion exchange resins (i.e., cholestyramine) Ingestion of calcium chloride or magnesium chloride Type I renal tubular acidosis (distal): Hypokalemic hyperchloremic metabolic acidosis: Type II renal tubular acidosis (proximal): Hypokalemic hyperchloremic metabolic acidosis: Acidosis limited by reabsorptive capacity of proximal tubule for HCO3 Type IV renal tubular acidosis (hypoaldosteronism): Hyperkalemic hyperchloremic acidosis: Aldosterone deficiency or resistance causing decreased H+ secretion Tachypnea or Kussmaul respirations with metabolic acidosis Hypoventilation with respiratory Continue reading >>

Medicowesome: Approach To Acid Base Disorders: Metabolic Alkalosis Notes

Medicowesome: Approach To Acid Base Disorders: Metabolic Alkalosis Notes

Approach to acid base disorders: Metabolic alkalosis notes In suspected metabolic alkalosis, always check urinary chloride levels. Metabolic alkalosis associated with a reduction in the ECV (Vomiting, diuretics): There will be a stimulus for Na and Cl reabsorption to replenish extracellular volume. Administration of NaCl and water leads to correction of the metabolic alkalosis. Such causes of metabolic alkalosis are said to be saline responsive. Metabolic alkalosis associated with an expanded volume state (Mineralocorticoid excess, Barrters, Gitelman syndrome): There is no stimulus forNa and Cl reabsorption. The urinary Cl will be high ( > 40 meq/L). Administration of saline would not correct the alkalosis. Such causes of metabolic alkalosis are said to be saline resistant. Check blood pressure in saline resistant metabolic alkalosis: Mineralocorticoid excess states tend to be associated with hypertension. Exogenous alkali load, Barrters and Gitelman's syndrome are associated with normal blood pressure. I had an interesting practice question about an anorexic bulimic patient, the tough part was differentiating alkalosis due to vomiting and alkalosis due to laxative abuse. They can be differentiated on the bicarbonate levels. Laxative abuse can decrease HCO3- because you are pooping bicarb out. Vomiting will cause a relative increase in HCO3- levels. For the sake of completion, I am enumurating all causes of matabolic alkalosis I can think of and dividing them into saline responsive and saline resistant :) Continue reading >>

Metabolic Alkalosis Nclex Review Notes

Metabolic Alkalosis Nclex Review Notes

Are you studying metabolic alkalosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember metabolic alkalosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate metabolic alkalosis from metabolic acidosis. Don’t forget to take the metabolic acidosis and metabolic alkalosis quiz. This article will cover: Metabolic alkalosis simplified Lab values expected with metabolic alkalosis Causes of metabolic alkalosis Signs and symptoms of metabolic alkalosis Nursing interventions for metabolic alkalosis Lecture on Metabolic Alkalosis Metabolic Alkalosis Metabolic alkalosis in simple terms: a metabolic problem caused by the excessive loss of acids (H+) or increased amount of bicarb (HCO3) produced in the body that leads to an alkalotic state in the body. Disease processes and drugs can cause metabolic alkalosis. When metabolic alkalosis happens in the body other systems try to compensate by hopefully fixing the blood’s pH and bicarb level. One system that does this is the respiratory system by stimulating the respiratory system to hypoventilate (decrease respirations) which will retain PCO2 (carbon dioxide) so it will decrease the pH back to normal, hence you will start to see bradypnea in your patient. If a patient is experiencing metabolic alkalosis they will present with the following labs: HCO3: increases >26 Blood pH: increases >7.45 CO2: >45 or normal (may be normal but if increased this is the body’s way of trying to compensate. Remember the respiratory system tries to decrease the pH from its alkalotic state by causing hypoventilation ( bradypnea). The respiratory system hopes that if the CO2 increase e Continue reading >>

Medical Mnemonics 4 U

Medical Mnemonics 4 U

Respiratory and Metabolic Alkalosis and Acidosis Mnemonics Remember ROME= Respiratory Opposite, Metabollic Equal. Explanation: Usually when pH decreases it is called acidosis and increase in pHis called alkalosis. There is no confusion to this point. Also I hope that you know that changes in PCO2 will lead to Respiratory acidosis / alkalosis and that in PHCO3 will lead to Metabolic acidosis / alkalosis. You can remember this by thinking that you respire PCO2 outside. Next, take the mnemonic ROME - In Respiratory alkalosis / acidosis, the pH and PCO2 levels are Opposite; This means that in Respiratory acidosis (which means pH is low) the PCO2 will be high or in other words low pH with high PCO2 is called Respiratory acidosis. In respiratory alkalosis there is high pH and low PCO2. In Metabollic acidosis / alkalosis, the pH and PHCO3 levels are Equal (Not quantitively, but it means that increasedpH and increased PHCO3 is the situation in Metabollic alkalosis and both are decreased in Metabolic acidosis). To remeber this in another way: In METabollic acidosis / alkalosis the values of pH and PHCO3 MEET. In Respiratory there are like RX - 'X' denotes into mark for opposite. Respiratory Raja's fight. Continue reading >>

Ep9: Acidosis Alkalosis And Ph

Ep9: Acidosis Alkalosis And Ph

Grab My Cheatsheet! Ready to Make Lab Values Quick and Easily Accessible? Use Skeletons! Alkalosis has a K, therefore it is Kicking the pH UP! Acidosis has a D, therefore it is dropping the pH DOWN! Ready to Make Lab Values Quick and Easily Accessible? Use Skeletons! Alright so this next memory device is to help you remember the location on the pH scale for alkalosis and acidosis. And it can be hard to remember in picture which one is on which side of that little scale. So, if you can remember that alkalosis has a K in it. Therefore, its kicking the pH up. So, alkalosis has a K in the word, therefore, its kicking the pH up. And then, if you can remember, acidosis has a D in it. Therefore, its dropping the pH down. So, lets go over that again. Alakalosis has a K, therefore, its kicking the pH up. Acidosis has a D, therefore its dropping the pH down. Alkalosis, K, kicking the pH up. Acidosis has a D, therefore, it is dropping the pH down. This has been another episode of the nursing mnemonics podcast by NRSNG.com with your host, Katie Kleber, RN, CCRN. To grab all of our nursing cheat sheets, head over to NRSNG.com/freebies. Thats NRSNG.com/freebies. Thank you so much for being here today. We love you guys. We thank you so much. We want to see you guys succeed. Listen, were all in this together. Now, go out and be your best self today. Happy Nursing. Continue reading >>

Respiratory, Metabolic, Acidosis, Alkalosis...what?!

Respiratory, Metabolic, Acidosis, Alkalosis...what?!

Respiratory, Metabolic, Acidosis, Alkalosis...WHAT?! I need someone to help me understand the differences between the four Acid-Base balances. How am I supposed to remember what the ph, co2, hco3, all do during these different conditions? Specialty: 5 year(s) of experience in ER The Basics (it can get much trickier than this!) If the ph is acidic (below 7.35) and the bicarb level is low, then it's metabolic acidosis. If the ph is alkalotic (above 7.45) and the bicarb level is high, then its metabolic alkalosis. If the pH is acidic and the CO2 is high, then it's respiratory acidosis. If the ph is alkalotic and the CO2 is low, then it's respiratory alkalosis. Of course, you can have partially compensated versions of these plus combinations of acidosis and alkalosis, respiratory AND metabolic....but what I described above are the basics. Here are some more detailed steps from my notes on ABGs: Step 4: Determine presence of compensation (this is where it gets tricky!) Are PaCO2 and HCO3- abnormal (or almost so?) in opposite directions (one acidotic, the other alkalotic)? If yes, then compensation is PRESENT. Is one component normal and the other abnormal? If yes, compensation is ABSENT and the problem is likely acute. Step 5: Identify the primary disorder, if possible -If pH is clearly abnormal, then the acid-base component most consistent with the pH disturbance is the primary disorder (see "basics" up above) -If pH is normal or near-normal, the more deviant component is the probable primary (also...note whehter pH is on the acidotic or alkalotic side of 7.4. the more deviant component should be consistent with this pH.) Step 6: Classify degree of compensation, if present Metabolic acidosis: the decrease in PaCO2 is approximately equal to the last two digits of the pH. Me Continue reading >>

Usmle Mcqs And

Usmle Mcqs And "pearls":

The pH of blood is normally kept constant by a series of buffers and by the bodys ability to excrete excess acid through the lungs and kidneys. The main buffering system is the bicarbonate-carbonic acid buffer, which is described by the following reaction: Normal ABG values for the pH, PaCO2, and HCO3- are as follows: The following steps are followed in working out acid-base problems. Also there are nomograms, and PDA programs (medmath) that calculate and interpret these problems. Pt. has vomiting (metabolic alkalosis), diarrhea (metabolic acidosis), renal failure (metabolic acidosis), toxic ingestion (metabolic acidosis), respiratory failure (respiratory acidosis), hyperventilation (respiratory alkalosis) or a combination of these? Normal values: pH = 7.4, PaCO2 = 40 mmHg, HCO3- = 24 mEq/L pH Primary Abnormality Secondary Abnormality Primary (1 process) 1. mmol/L and mEq/L are same in calculations. 2. PaCO2 and HCO3- always go in the same direction. If they go in different directions, a mixed acid-base d/o is present. 3. Metabolic alkalosis is the most common type of acid-base disorder. 4. If HCO3- is 13 mEq/L, then 1 disturbance is metabolic acidosis, regardless of other ABG values. 5. For simple acid-base d/o, think the following: if pH and HCO3- move in the same direction, think metabolic acidosis/alkalosis. If pH and PaCO2 move in the opposite directions think respiratory acidosis/alkalosis. Use Winters formula. PaCO2 = 1.5 x HCO3- + 8 2 Compare the Pts calculated PaCO2 to the Pts actual measured PaCO2 on ABG If actual PaCO2 < PaCO2 calculated, then respiratory alkalosis coexists with metabolic acidosis. If actual PaCO2 > PaCO2 calculated, then respiratory acidosis coexists with metabolic acidosis. If actual PaCO2 = PaCO2 calculated, then metabolic acidosis exists Continue reading >>

High Anion Gap Metabolic Acidosis

High Anion Gap Metabolic Acidosis

When acidosis is present on blood tests, the first step in determining the cause is determining the anion gap. If the anion gap is high (>12 mEq/L), there are several potential causes. High anion gap metabolic acidosis is a form of metabolic acidosis characterized by a high anion gap (a medical value based on the concentrations of ions in a patient's serum). An anion gap is usually considered to be high if it is over 12 mEq/L. High anion gap metabolic acidosis is caused generally by acid produced by the body,. More rarely, high anion gap metabolic acidosis may be caused by ingesting methanol or overdosing on aspirin.[1][2] The Delta Ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present. The list of agents that cause high anion gap metabolic acidosis is similar to but broader than the list of agents that cause a serum osmolal gap. Causes[edit] Causes include: The newest mnemonic was proposed in The Lancet reflecting current causes of anion gap metabolic acidosis:[3] G — glycols (ethylene glycol & propylene glycol) O — oxoproline, a metabolite of paracetamol L — L-lactate, the chemical responsible for lactic acidosis D — D-lactate M — methanol A — aspirin R — renal failure K — ketoacidosis, ketones generated from starvation, alcohol, and diabetic ketoacidosis The mnemonic MUDPILES is commonly used to remember the causes of increased anion gap metabolic acidosis.[4][5] M — Methanol U — Uremia (chronic kidney failure) D — Diabetic ketoacidosis P — Paracetamol, Propylene glycol (used as an inactive stabilizer in many medications; historically, the "P" also stood for Paraldehyde, though this substance is not commonly used today) I — Infectio Continue reading >>

6.2 Respiratory Alkalosis - Causes

6.2 Respiratory Alkalosis - Causes

Hyperventilation is the mechanism in ALL cases Hyperventilation (ie increased alveolar ventilation) is the mechanism responsible for the lowered arterial pCO2 in ALL cases of respiratory alkalosis. This low arterial pCO2 will be sensed by the central and peripheral chemoreceptors and the hyperventilation will be inhibited unless the patients ventilation is controlled. 1. Central Causes (direct action via respiratory centre) Other 'supra-tentorial' causes (pain, fear, stress, voluntary) Various drugs (eg analeptics, propanidid, salicylate intoxication) Various endogenous compounds (eg progesterone during pregnancy, cytokines during sepsis, toxins in patients with chronic liver disease) 2. Hypoxaemia (act via peripheral chemoreceptors) Respiratory stimulation via peripheral chemoreceptors 3. Pulmonary Causes (act via intrapulmonary receptors) 4. Iatrogenic (act directly on ventilation) Can a decreased CO2 production cause respiratory alkalosis? Hyperventilation is the mechanism in all of the situations in the above list & indeed in all cases. Theoretically, a decreased carbon dioxide production could result in respiratory alkalosis if alveolar ventilation remained fixed. But this would not occur in a normal person because any drop in arterial pCO2 would reflexly cause a decreased ventilation (via chemoreceptor inhibitory input into the respiratory centre). About the only situation where maybe a decrease in CO2 production could be the mechanism of respiratory alkalosis would be in an intubated patient on fixed ventilation during Anaesthesia or in Intensive Care Unit and where the CO2 production was low due to hypothermia and decreased metabolic rate. However, even in such a circumstance, this mechanism is usually referred to as 'excessive controlled ventilation' (which it Continue reading >>

Metabolic Acidosis

Metabolic Acidosis

Increases 0.3-0.7 mEq/l [0.3-0.7 mmol/L] per 0.1 decr pH Difference between measured plasma cation (ie, Na+) and anions (ie, chloride (Cl-), HCO3-) concentrations Lactic acidosis (mild LA may have normal AG) Also called hyperchloremic acidosis (decreased HCO3, increased Cl) Renal tubular acidosis: impairment in renal acidification Type III (term no longer used) Formerly used to define distal RTA with bicarbonate wasting in children Bicarbonaturia resolves with age and is not truly part of a pathologic process Type IV: common in obstructive nephropathy, DM, hyporenin/hypoaldosteronehyper K+, acidosis Intestinal loss of bicarbonate (diarrhea, pancreatic fistula) Carbonic anhydrase inhibitors (e.g. acetazolamide) Dilutional acidosis (due to rapid infusion of bicarbonate-free isotonic saline) Ingestion of exogenous acids (ammonium chloride, methionine, cystine, calcium chloride) Drugs: amiloride, triamterine, Bactrim, chemotherapy, pentamidines As diagnostic aid, is not absolute "Delta gap" = calculated anion gap:nl anion gap In anion gap acidosis, "delta gap" should equal "delta HCO3" If HCO3 higher than predictedsuperimposed metabolic alkalosis If HCO3 lower than predictedsuperimposed non-anion gap metabolic acidosis Allows diagnosisof mixed metabolic disturbance Mixed metabolic disturbance plus respiratory disturbance Check urine pH before initializing therapy NaHCO3 therapy for pH < 7.1 - 7.2 Only used emergently to raise pH to > 7.1 or 7.2 Controversial, depends on disorder and symptoms i.e. NaHCO3 not beneficial in DKA treatment with pH under 7.0) DO NOT give this entire amount 2 ampulesof 8.4% NaHCO3 in 1 Liter of 1/4 NS OR 3-4 ampulesof 8.4% NaHCO3 in 1 Liter D5W Overaggressive NaHCO3"overshoot alkalosis" Bicarbonate level should be corrected only to 15 mEq/L [15 m Continue reading >>

Metabolic Acidosis Nclex Review Notes

Metabolic Acidosis Nclex Review Notes

Are you studying metabolic acidosis and need to know a mnemonic on how to remember the causes? This article will give you a clever mnemonic and simplify the signs and symptoms and nursing interventions on how to remember metabolic acidosis for nursing lecture exams and NCLEX. In addition, you will learn how to differentiate metabolic acidosis from metabolic alkalosis. Don’t forget to take the metabolic acidosis and metabolic alkalosis quiz. This article will cover: Metabolic acidosis simplified Lab values expected with metabolic acidosis Causes of metabolic acidosis Signs and symptoms of metabolic acidosis Nursing interventions for metabolic acidosis Lecture on Metabolic Acidosis Metabolic Acidosis Metabolic Acidosis in Simple Terms: a metabolic problem due to the buildup of acid in the body fluids which affects the bicarbonate (HCO3 levels) either from: increased acid production (ex: DKA where ketones (acids) increase in the body which decreases bicarbonate) decreased acid excretion (ex: renal failure where there is high amount of waste left in the body which causes the acids to increase and bicarb can’t control imbalance) loss of too much bicarb (diarrhea) When this acidic phenomena is taking place in the body other systems will try to compensate to increase the bicarb back to normal. One system that tries to compensate is the respiratory system. In order to compensate, the respiratory system will cause the body to hyperventilate by increasing breathing through Kussmaul’s respirations. Kussmaul respirations are deep, rapid breathes. The body hopes this will help expel CO2 (an acid) which will “hopefully” increase the pH back to normal. Lab values expected in Metabolic Acidosis: HCO3: decreased <22 Blood pH: decreased <7.35 CO2: <35 or normal (may be normal b Continue reading >>

Nclex Must Know Mnemonics- S/s Hypo-hyper- Electrolyte, Acidosis, Alkalosis, Shock/icp

Nclex Must Know Mnemonics- S/s Hypo-hyper- Electrolyte, Acidosis, Alkalosis, Shock/icp

Hypercalcemia s/s (5 points, 1 for each of the finger 'BONES') (If you can remember that calcium build bones, you can remember the 1st part: bones...) Moans: (joints, muscles, energy level) fatigue, myalgia, proximal muscle weakness, joint pain Psychic Overtones of a Jones: memory loss and lethargy (classic psyche of pot abuser), depression (can't get drug), confusion (with harder drug), coma (O.D.) (To remember what mnemonic to use imagine: no calcium, you're completely out of milk, and your cats are milling around hungry...) Decreased heart rate, peripheral pulses, and BP ECG - prolonged ST interval and prolonged QT interval C - CNS effects ( early: C-onfusion, N-ew personality: irritable, No energy; S-eizures) T - Tetany, Tingling around mouth (involuntary contraction of muscles/Chvostek's sign/spasms) S - Stridor (from bronchospasm, may begin with wheezing) (Think of not enough salt because you lost it...[stupid, starts w/stupor]) O-rthostatic hypotension (due to loss of water in blood; which would increase urinary output and lower specific gravity of urine) S-eizures as late sign; headache early sign (Remember that any change in hydration of brain cells can cause: headache, dizziness, stupor, coma, confusion, nausea/vomiting/stomach cramping...) (Think: you have so much salt, it's in the fridge in the cupboards, so you fry it up for the next meal...) E - Edema (peripheral and pitting), ecitability neuromuscular S = seizure, coma, confusion, headache (from water-logged brain cells) A = Agitated, Anorexia with nausea and vomiting (Remember that any change in hydration of brain cells can cause: headache, dizziness, stupor, coma, confusion, nausea/vomiting/stomach cramping...) (To remember what mnemonic to use imagine: you are the monkey king of the jungle, protecting Continue reading >>

Renal Fellow Network: Mnemonic For Non-anion Gap Metabolic Acidosis

Renal Fellow Network: Mnemonic For Non-anion Gap Metabolic Acidosis

Mnemonic for NON-Anion Gap Metabolic Acidosis As I've mentioned previously on this blog, the "MUDPALES" mnemonic for anion gap metabolic acidosis is one of the most successful medical mnemonic's of all time. A less successful (and admittedly less useful) mnemonic exists for non-anion gap metabolic acidoses (NAGMA), which I learned as a resident. It's "HARDUP", which stands for the following: H = hyperalimentation (e.g., starting TPN). R = renal tubular acidosis (Type I = distal; Type II = proximal; Type IV = hyporeninemic hypoaldosteronism. U = uretosigmoid fistula (because the colon will waste bicarbonate). P = pancreatic fistula (because of alkali loss--the pancreas secretes a bicarbonate-rich fluid). Practically speaking however, the two main causes you really have to remember for NAGMA are DIARRHEA or RENAL TUBULAR ACIDOSIS, which 90% of the time you can distinguish between based on the history alone. Another way to think about the differential diagnosis of NAGMA is to ask whether or not there is GI LOSS or RENAL LOSS of bicarbonate. If the history does not provide an obvious explanation, one can distinguish between GI versus renal bicarbonate losses by determining the urine anion gap (urine AG = urine Na + urine K - urine Cl), where a positive value indicates renal bicarbonate loss whereas a largely negative value indicates extra-renal bicarbonate loss. Continue reading >>

More in ketosis