Approach to acid base disorders -1

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Which of the following correctly lists the major approaches to acid-base analysis in clinical practice?

Physiologic, Stewart and Base Excess approaches

Respiratory, Renal and Metabolic approaches

Bicarbonate-based, Anion Gap-based and Oxygenation-based approaches

Clinical, Laboratory and integrated approaches

None

In the physiological (bicarbonate-based) approach to acid-base disorders, which of the following pairs are considered the primary components of the Henderson-Hasselbalch equation?

Sodium and Chloride

Bicarbonate and Partial Pressure of Carbon Dioxide (PaCO₂)

Anion Gap and Albumin

Base Excess and Strong Ion Difference

None

Which of the following best describes the Isohydric Principle in acid-base physiology?

The body maintains pH by altering sodium and potassium levels simultaneously

Only one buffer system operates at a time to correct an acid-base disturbance

Multiple buffer systems in the body act simultaneously and reach equilibrium with the same hydrogen ion concentration

The buffering capacity of the blood depends solely on the bicarbonate buffer system

None

Which of the following best describes the expected secondary (compensatory) response in a patient with acute respiratory acidosis?

Increase in bicarbonate by 4 mEq/L for every 10 mmHg rise in PaCO₂

Increase in bicarbonate by 1 mEq/L for every 10 mmHg rise in PaCO₂

Decrease in bicarbonate by 2 mEq/L for every 10 mmHg fall in PaCO₂

No change in bicarbonate level

None

Which of the following best explains the purpose of calculating the anion gap in acid-base disorders?

To determine the extent of renal compensation in metabolic alkalosis

To differentiate between respiratory and metabolic causes of acidosis

To detect the presence of unmeasured anions in metabolic acidosis

To detect co-existing metabolic alkalosis

None

Which of the following formulas is used to correct the anion gap for hypoalbuminemia?

Corrected AG = AG + 2 × (albumin in g/dL)

Corrected AG = AG – (2.5 × albumin in g/dL)

Corrected AG = AG + [2.5 × (4 – albumin in g/dL)]

Corrected AG = AG × (albumin / 4.0)

None

In a patient with acid base disorder, the delta ratio helps in?

Assessing renal compensation

Determining if there is a mixed acid-base disorder

To assess respiratory acidosis

None of the above

None

Which of the following is a key limitation of the physiological (bicarbonate-based) approach to acid-base analysis?

It is based on directly measured parameters like pH and PaCO₂ for interpretation

It interprets metabolic disturbances using changes in bicarbonate concentration

It ignores the influence of non-bicarbonate buffers in plasma

It provides a straightforward framework that aligns well with traditional teaching and clinical workflows.

None

A 24-year-old woman with type 1 diabetes mellitus presents with nausea, vomiting, abdominal pain, and drowsiness. On examination, she is tachypnoeic with deep, laboured breathing (Kussmaul respiration).

Labs are as follows: Na⁺: 132 mEq/L, Cl⁻: 95 mEq/L, HCO₃⁻: 7 mEq/L, Glucose: 460 mg/dL, Albumin: 2.5 g/dL, Ketones: Positive, Arterial pH: 7.12, PaCO₂ = 20 mmHg

Normal anion gap metabolic acidosis due to bicarbonate loss

High anion gap metabolic acidosis due to ketone accumulation

Mixed respiratory alkalosis and metabolic alkalosis

High anion gap metabolic acidosis due to lactic acidosis

None

10.

A 68-year-old man with severe COPD on long-term oxygen therapy and thiazide diuretics presents with lethargy. ABG and labs reveal: pH = 7.32,PaCO₂ = 65 mmHg, HCO₃⁻ = 41 mEq/L, Na⁺ = 146 mEq/L, Cl⁻ = 97 mEq/L, Albumin = 4.0 g/dL

What is the most likely acid-base disorder?

Mixed respiratory alkalosis and metabolic alkalosis

Chronic respiratory acidosis with appropriate renal compensation

Chronic respiratory acidosis with superimposed metabolic alkalosis

Chronic respiratory acidosis with superimposed high anion gap metabolic acidosis

None

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