1. Your 15-year-old daughter, Fatamorgana, has been ill for 3 days with a fever, lassitude, anorexia, sore anus and elbows, and frequent diarrhea. She has gone through a big bottle of Tums in the last 2 days. You’ve heard of “antacid abuse,” and wonder if you should take the Tums away from her. Do you? A. Yes! She is giving herself a case of respiratory acidosis.

B. Yes! She surely has given herself a case of metabolic alkalosis by now.

C. No! She is probably doing the right thing here, and took her advice from a physiology textbook instead of a popular magazine, or Dr. Oz.

D. No! But she also needs some acidity, for acid-base balance, so you have her drink a 2 cups of all-natural apple cider vinegar you got from the health aisle of the local grocery store.

2. You do take the Tums away from Fatamorgana, just to see if she gets better. Later that day, you find her lying on the bathroom floor, exhausted by toilet effort and her overall lack of calories. You notice her breathing is strange. What is this breathing like, and what do you do about it? (ASSUMING no other medical care is available – there has been an ice storm, say.)

A. She is inhaling only every 15 seconds, and you feed her some non-diet Coca-Cola in a cup because she is too weak to raise her head to drink.

B. Although not seeming in distress or turning funny colors in the face, she is breathing so infrequently that you call an ambulance.

C. She is breathing very rapidly. You give her a liter of bottled water, make her a big glass of Alka-Seltzer, and give her an emetic.

D. She has Kussmaul respirations so you have her breathe into a paper bag.

3. Normal lab values should be second nature to you. You are reading an issue of the NEJM. The patient being discussed has a bicarb of 22, CO2 33, and pH 7.66. What is the term for this combination of numbers?

A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

4. For the NEJM case in Question #3, the cause of the low-ish bicarb value is:

A. probably ingested a lot of it B. either diarrhea or vomiting

C. respiratory compensation D. renal compensation E. bad kidneys

5. Your great aunt in the nursing home acquired a nosocomial cystitis, which then became nephritis. What are a likely pH & bicarb her, respectively?

A. low & high B. high & low C. low & low D. high & high

6. Miss Holly Golightly of Myrtle Beach drives to her mountain cabin in Blowing rock, NC, to try to recuperate from her new-onset panic attacks. Soon after arriving, she sees a large rattlesnake in the kitchen sink, runs away, and snaps her ankle (fibula).
How many causes of pH shift are mentioned in this scenario?

A. 1 B. 2 C. 3 D. 4 E. 5 F. 6

7. Can all three arrows in an acid-base disorder be pointing in the same direction?

A. Yes, if it’s respiratory

B. Yes, if it’s metabolic

C. No, this would be extremely unusual, medically speaking

D. No, the renal and respiratory compensations we learned about will prevent this

8. Which of these will have a CO2 level that is a result of compensation, instead of being a cause of the pH problem in the first place?

A. drinking vinegar B. has pneumonia C. heart attack D. running a mile

9. When the value for CO2, or bicarb, in a patient, is definitely high, or definitely low, it must always be treated.

A. True, that’s what made them ill in the first place

B. False, it may actually be helping the patient from being even more ill

10. When the CO2 and pH arrows are in opposite directions, the situation is always (practically speaking) a respiratory alkalosis or acidosis. A. True B. False