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High Acuity > Acid Base Balance > Flashcards

Acid Base Balance Flashcards

1
Q

Acid + example

A

substance that releases H+ when dissolved in water/body fluids

H+ = proton

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2
Q

Base + example

A

substance that accepts or binds to hydrogen ions

HCO3-

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3
Q

Acidosis

A

the process by which protons are produced in a large amount

increase in proton production

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4
Q

Alkalosis

A

the process by which there is a decrease in proton production/concentration (H+)

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5
Q

Buffer

A

can react as either acid or base, depending on pH of the solution

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6
Q

What are arterial blood gases

A

Provide valuable information on patient’s acid-base and oxygenation status

Reflect respiratory and metabolic functions

Constant byproduct of cellular metabolism: CO2 and water

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7
Q

What is pH and normal value?

A

7.35-7.45
* Concentration of hydrogen ions
* Hydrogen ions = acidic

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8
Q

What does PCO2 tell you and normal value?

A

35-45mmHg

Partial pressure of carbon dioxide

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9
Q

The amount of CO2 is directly proportional to:

A

the number of hydrogen ions; corresponds with acid

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10
Q

The more carbon dioxide in your blood the more _____ your blood is

A

Acidic

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11
Q

Carbon dioxide levels will be altered in ______

A

respiratory acidosis/alkalosis

Controlled by lungs

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12
Q

Bicarb normal value

A

22-28mmol/l

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13
Q

The more bicarbonate you have in your blood, the more ____ it is

A

basic

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14
Q

Bicarbonate levels will be altered in:

A

Metabolic acidosis/alkalosis

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15
Q

Normal PaO2 levels and when are decreases seen?

A

80-100mmHg

decreases above sea level and with increasing age

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16
Q

What does PaO2 give information on?

A

does not give information on whether patient is in respiratory/metabolic acidosis only hypoxemia

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17
Q

Normal base excess level

A

0 + 2.0mEq/L

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18
Q

4 Steps of ABG analysis

A
  1. Identify acidosis/alkalosis
    - look at pH
  2. Identify respiratory/metabolic
    - look at CO2 (altered in resp)
    - look at HCO3 (altered in metabolic)
  3. Identify compensation
    - other value normal = none
    - other value outside = compensated
    > normal pH = full
    > abnormal pH = partial
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19
Q

Respiratory Alkalosis Values

A

high pH, low CO2, normal HCO3 (unless compensated)

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20
Q

Respiratory Acidosis Values

A

low pH, high CO2, normal HCO3 (unless compensated)

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21
Q

Metabolic Alkalosis Values

A

high pH, high HCO3, normal CO2 (unless compensated)

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22
Q

Metabolic Acidosis Values

A

low pH, low HCO3, normal CO2 (unless compensated)

23
Q

What causes respiratory acidosis + 3 conditions

A

Retention of CO2
* CNS Depression
* Neuromuscular Disorder
* Obstructive Lung Disease

24
Q

What causes respiratory alkalosis + 3 conditions

A

Excretion of CO2
* CNS Hyperactivity (anxiety, fever, pain)
* Hypoxemia - can stimulate hyperventilation
* Increased ICP

25
Q

What 3 things cause metabolic acidosis?

A

Gain of Acid (DKA, lactic acidosis)

Loss of Base

Inability to excrete acid

26
Q

What 3 things cause metabolic alkalosis?

A

Loss of Acid (vomiting, increased aldosterone, total volume loss, administration of NaHCO3)

gain of base

excessive renal loss

27
Q

Effects of acidosis on the heart

A
  1. hypotension due to decreased contractility, decreasing CO and MAP
  2. hypotension due to increased vasodilation
  3. increased HR causing VT arrhythmias
  4. resistance to vasopressors
28
Q

Effects of alkalosis on the heart

A
  1. increases vasoconstriction
  2. increases HR leading to VT arrhythmias, vfib, SVT arrhythmias
29
Q

Effects of acidosis on the lungs

A

increases RR - increased WOB - fatigue

30
Q

Effects of alkalosis on the lungs

A

decreases RR - hypoxemia

31
Q

Effects of acidosis on metabolism

A
  1. high proton concentration causes extra to intracellular fluid shift, increasing potassium ARRHYTHMIA RISK
  2. high proton concentration alters insulins effect, promoting resistance INCREASING BG
32
Q

Effects of alkalosis on metabolism

A

Decreases potassium and magnesium (to a lesser extent)

33
Q

Effects of acidosis on CNS

A

Altered mental status – coma

34
Q

Effects of alkalosis on CNS

A

Altered mental status – coma

Seizures/tetany

35
Q

Volatile Acids

A

Can be converted to gas for excretion by lungs

carbonic acid to carbon dioxide

36
Q

Example of volatile acid

A

Carbonic acid

37
Q

Nonvolatile acids

A

Metabolic acids

Cannot be converted to gas; must be excreted by kidneys

Can only do a small amount each day - slow process

38
Q

Nonvolatile acid examples and how they are formed

A
  1. Sulfuric acid: formed by protein breakdown
  2. Fatty acids & ketoacids: formed by fat breakdown
  3. Lactic acid: when cells metabolize under anaerobic (no oxygen) conditions
39
Q

How does the body acutely respond to acid base imbalances?

A

The bicarb/carbonic acid buffer system

40
Q

What occurs in the buffer system when there is a low pH?

A

Bicarbonate can bind to free H+ when too many are present, or release them when not enough are present, forming carbonic acid

Carbonic acid can then be excreted through lungs

41
Q

What occurs in the buffer system when there is a high pH?

A

If there are too few H+ ions, carbonic acid will disassociate into a hydrogen ion and bicarbonate

42
Q

What does the carbonic anhydrase equation show

A

This reaction (driven by carbonic anhydrase enzyme) shows how H+ and CO2 levels are directly related. An increase in one causes an equal increase in the other

43
Q

Describe the carbonic anhydrase equation?

A

carbon dioxide + water <> carbonic acid <> hydrogen + bicarbonate

44
Q

What are the 3 buffering systems in the body?

A
  1. Bicarbonate - acute/not highly effective
  2. respiratory - fast system based on chemoreceptors of CO2 concentration
  3. renal - slower regulates HCO3
45
Q

How do the lungs compensate/act as an acid-base buffer system?

A

Control carbon dioxide and thus carbonic acid excretion

Ventilation based on CO2 levels via chemoreceptors

46
Q

How do the lungs compensate in acidosis?

A

Increased Rate and depth of ventilation = attempt to rid body of CO2
* Low pH stimulates chemoreceptors in CNS  stimulates an increase in RR (in attempt to breathe off CO2)

47
Q

How do the lungs compensate in alkalosis?

A

Decreased Rate and depth of ventilation = retention of CO2
* High pH inhibits chemoreceptors in CNS  lower RR  retention of CO2

48
Q

How do the kidneys compensate/act as an acid-base buffer?

A

Takes hours to days/longer
* Regulate HCO3- level (excretion and reabsorption) in the renal tubules

49
Q

How do the kidneys compensate in acidosis?

A

kidneys excrete H+ and conserve HCO3-

50
Q

How do the kidneys compensate in alkalosis?

A

kidneys retain H+ and excrete (/decrease resabsorption) HCO3-

51
Q

Uncompensated ABG values

A
  • Abnormal pH
  • One abnormal and one normal value (other system has not been compensated)
52
Q

Partially compensated ABG values

A
  • Abnormal pH
  • Two abnormal values (opposite system has attempted to compensate)
53
Q

Fully compensated ABG values

A
  • Normal pH
  • Two abnormal values (opposite system has compensated enough to move pH into normal range)

High Acuity (20 decks)

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