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Apex Review > Fluids, electrolytes, & acid-base 4 > Flashcards

Fluids, electrolytes, & acid-base 4 Flashcards

1
Q

The body attempts to regulate blood pH to

A

7.40

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2
Q

Normal pH is

A

7.35-7.45

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3
Q

Acidosis pH is

A

<7.35

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4
Q

_______________ details how PaCO2 and HCO3 influence pH.

A

The Henderson-Hasselbalch equation

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5
Q

Buff systems that help mitigate pH changes include

A

the blood (bicarbonate & hemoglobin)
lungs (changes in ventilation)
kidneys

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6
Q

What is normal HCO3?

A

22-26 mEq/L

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7
Q

What 5 questions should you ask yourself when evaluating pH?

A
  1. Is the pH normal
  2. Is the PaCO2 normal
  3. Is the HCO3- normal
  4. Has compensation occurred?
  5. If there’s metabolic acidosis, is the anion gap normal or increased?
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8
Q

Acidosis causes ___________________ P50, SNS stimulation, risk of dysrhythmias, myocardial depression, increased pulmonary vascular resistance, hyperkalemia, and increased ICP

A

Increased

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9
Q

Alkalosis causes ______________ P50, decreased coronary blood flow, risk of dysrythmias, decreased cerebral blood flow, decreased pulmonary vascular resistance, hypokalemia, and decreased ionized calcium.

A

decreased

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10
Q

H+ is __________ cells and K+ is _____________ cells

A

transported into cells and K+ is transported out of cells

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11
Q

Acidosis is often accompanied by _________kalemia

A

hyperkalemia

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12
Q

What is a normal anion gap?

A

8-12 mEq/L

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13
Q

Metabolic acidosis can have a

A

normal anion gap & an increased anion gap

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14
Q

Reasons for an increased anion gap in the setting of metabolic acidosis include

A

MUDPILES
methanol
uremia
diabetic ketoacidosis
paraldehyde
isoniazid
lactate
ethanol, ethylene glycol
salicylates

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15
Q

Reasons for a normal anion gap in the setting of metabolic acidosis include

A

HARDUP
hyperaldosteronism
acetazolamide
renal tubular acidosis
diarrhea
uretosigmoid fistula
pancreatic fistula

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16
Q

Full compensation causes pH

A

to return to normal

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17
Q

Compensation for metabolic disorders is ________- due to changes in _______________

A

rapid; changes in minute ventilation

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18
Q

Consider a mixed disorder if

A

the PaCO2 & bicarb both shift towards acidosis or alkalosis
the PaCO2 & bicarb are abnormal, but the expected degree of compensation did not occur

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19
Q

Which acid-based disorder is MOST likely to occur in response to untreated pain in the PACU?
a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis

A

b. respiratory alkalosis

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20
Q

Respiratory acidosis occurs when

A

alveolar ventilation fails to keep up with CO2 production

21
Q

Causes of hypercarbia include

A

increased CO2 production
decreased CO2 elimination
rebreathing

22
Q

Reasons for increased CO2 production include

A

sepsis
thyroid storm
MH

23
Q

Reasons for decreased CO2 elimination include

A

airway obstruction
COPD
opioid overdose

24
Q

Reasons for rebreathing include

A

incompetent unidirectional valve
exhausted soda lime

25
Q

Mechanical ventilation is indicated when the pH is less than

A

7.20

26
Q

Respiratory alkalosis occurs when

A

alveolar ventilation exceeds CO2 production

27
Q

Causes of respiratory alkalosis include

A

iatrogenic (mechanical ventilation)
pain
pulmonary embolism
hypoxia
anxiety
pregnancy
drugs (progesterone, salicylates)

28
Q

With acute respiratory acidosis, for every 10 mmHg increase in PaCO2, pH

A

decreases by 0.08

29
Q

With chronic respiratory acidosis, for every 10 mmHg increase in PaCO2, pH

A

decreases by 0.03

30
Q

During respiratory acidosis, the kidneys

A

excrete hydrogen & conserve bicarbonate to return pH to normal

31
Q

In the lungs, CO2 is a

A

direct-acting vasoconstrictor, where it can cause pulmonary hypertension and increase the right ventricular workload

32
Q

The most common cause of respiratory acidosis is

A

hypoventilation

33
Q

The MOST likely etiologies of metabolic alkalosis include: (select 2)
a. large volume resuscitation with NaCl
b. vomiting
c. massive transfusion
d. diabetic ketoacidosis

A

b. vomiting
c. massive transfusion

34
Q

Metabolic acidosis is caused by an

A

accumulation of nonvolatile acids
loss of bicarbonate
large volume resuscitation with a sodium chloride solution

35
Q

_____________ helps to determine the cause of acidosis

A

the anion gap

36
Q

An increased anion gap occurs in the setting of

A

diabetic ketoacidosis, salicylates, and cyanide poisoning

37
Q

A normal anion gap occurs in the setting of

A

diarrhea, pancreatic fistula, and resuscitation with NaCl solutions

38
Q

_______________ used for anion gap acidosis is controversional.

A

Sodium bicarbonate

39
Q

Sodium bicarbonate is best used as a

A

temporary measure if the pH is <7.2 and the patient is hemodynamically unstable

40
Q

Metabolic alkalosis is caused by

A

increased bicarbonate (iatrogenic), loss of nonvolatile acids (continuous NG suction), and increased mineralocorticoid activity (Cushing’s syndrome)

41
Q

How do you calculate the anion gap?

A

Na+ - Cl- + HCo3

42
Q

Accumulation of acid leads to

A

gap acidosis

43
Q

Loss of bicarbonate or ECF dilution leads to

A

non-gap acidosis

44
Q

An anion gap acidosis is defined as

A

pH <7.35 and anion gap >14

45
Q

PaCO2 decreases by _______ for every HCO3- decrease of 1 mEq/L

A

1-1.5 mmHg

46
Q

Administering sodium bicarbonate for non-anion gap acidosis is generally

A

useful because most of the etiologies produce bicarbonate loss

47
Q

PaCO2 increases by _______- for every HCO3- increase of 1 mEq/L

A

0.5-1 mmHg

48
Q

Treatment for metabolic alkalosis includes

A

treat the underlying cause
-acetazolamide (increases renal excretion of bicarb)
dialysis
-spironolactone (mineralcorticoid antagonist)

49
Q

Name 5 etiologies that lead to metabolic alkalosis.

A

massive blood transfusion
vomiting
diuretics
Cushing’s syndrome
hyperaldosteronism

Apex Review (224 decks)

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