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IMF-019-02-0001-en	State the manuscript's estimate of the expected carbon dioxide in metabolic acidosis.	Approximately one and a half times the bicarbonate plus eight, with a small acceptable range.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0002-en	Bicarbonate is 8 in metabolic acidosis and the measured carbon dioxide is 32. Work out the expected value and interpret the difference.	One and a half times 8 is 12, plus 8 gives an expected carbon dioxide of about 20, so a measured 32 is higher than expected and indicates concurrent ventilatory failure.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0003-en	Bicarbonate is 12 and the measured carbon dioxide is 18. What does the rule predict, and what does the measured value indicate?	One and a half times 12 is 18, plus 8 gives an expected carbon dioxide of about 26, so a measured 18 is lower than expected and indicates an additional respiratory alkalosis.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0004-en	Why is loss of respiratory compensation urgent in severe metabolic acidosis, and what makes intubation hazardous?	The patient must sustain a high minute ventilation, so sedation, fatigue, chest disease, or neuromuscular weakness causes a sudden pH fall, and intubation is hazardous if post-intubation ventilation fails to match the previous compensatory demand.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0005-en	Carbon dioxide has risen. How do you read a bicarbonate that is lower, or higher, than that rise would predict?	Acute retention raises bicarbonate only a little through buffering and chronic retention raises it more through renal acid excretion, so less bicarbonate than expected suggests a concurrent metabolic acidosis and more suggests metabolic alkalosis or a higher previous baseline.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0006-en	What is post-hypercapnic metabolic alkalosis, and what maintains it?	After chronic hypercapnia is corrected rapidly with ventilation the retained bicarbonate stays temporarily high, and volume depletion, chloride deficiency, potassium loss, and diuretics maintain it.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0007-en	Baseline anion gap 12 and bicarbonate 24; the patient now has an anion gap of 24 and a bicarbonate of 4. Apply the delta comparison.	The gap has risen by 12 while bicarbonate has fallen by 20, so bicarbonate has fallen much more than the gap rose and a concurrent normal-gap acidosis is likely.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0008-en	How is the urine anion gap calculated, and what do a negative and a positive value suggest?	Sodium plus potassium minus chloride; a negative value suggests high ammonium chloride excretion and an appropriate renal response as in diarrhoea, and a positive value suggests reduced ammonium.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0009-en	Lactate is clearing but the pH stays low after chloride-rich resuscitation. What has happened, and why is it not treatment failure?	The organic-gap acidosis has been replaced by a hyperchloraemic acidosis as lactate or ketones clear, so the pH can remain low while perfusion is in fact improving.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0010-en	In the physicochemical approach, how do giving chloride and losing chloride move the strong-ion difference and the pH?	Giving chloride narrows the strong-ion difference and promotes acidosis, while losing chloride, or adding sodium without accompanying chloride, widens it and promotes alkalosis.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0011-en	Which weak acids does the physicochemical approach use besides carbon dioxide and the strong-ion difference, and what does a low albumin do?	Weak acids such as albumin and phosphate; a low albumin exerts an alkalinising effect that can offset another acidosis.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0012-en	Why can bicarbonate therapy worsen intracellular or central acidity even though blood bicarbonate rises?	It generates carbon dioxide, and if ventilation cannot eliminate the carbon dioxide produced, the acidity inside cells and centrally may worsen.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0013-en	When must a normal pH not end the analysis, and what confirms that treatment is working?	When carbon dioxide and bicarbonate are both markedly abnormal; serial measurements should confirm that ventilation, perfusion, renal response, and treatment are moving each process toward recovery without creating another disorder.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending
IMF-019-02-0014-en	What should the final acid-base interpretation state?	Every primary process, the expected compensation, the gap and albumin context, the likely cause, and the immediate physiological danger.	Integrated Medical Foundations; chapter 19, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f84635f2d747d94bd6530a6e1cfffc0058ac459ca86b2388bcaf7e3267f40b48; editorial review pending	imf lang::en chapter::019 module::019-02 review::pending