Packet 10 - Fluid Balance (3)

Question 1

Arterial Blood Gas Values

What are the normal ABG ranges for PaCO₂ ?

Answer 1

PaCO₂ → 35-45 mm Hg

(respiratory indicator of acid/base balance)

HCO₃^- → 22-26 mEq/L

(metabolic indicator of acid/base balance)

pH → 7.35-7.45

Question 2

Arterial Blood Gas Values

What are the normal ABG ranges for HCO₃^- ?

Answer 2

PaCO₂ → 35-45 mm Hg

(respiratory indicator of acid/base balance)

HCO₃^- → 22-26 mEq/L

(metabolic indicator of acid/base balance)

pH → 7.35-7.45

Question 3

Panic attacks and/or anxiety attacks cause hyperventilation.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 3

Respiratory Alkalosis

Primary deficit of carbonic acid

P/C Factors:

• Hyperventilation
  
  • increase in respiratory rate (i.e. panic attacks, anxiety, lung disease, hypoxia, fever)

Question 4

Caused by renal failure and/or diabetic ketoacidosis.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 4

Metabolic Acidosis

Primary deficit in base / bicarbonate

P/C Factors:

• Excess metabolic acids
  
  • increased production (i.e. lactic acidosis, ketoacidosis)
  • impaired kidney function (i.e. decrease in acid excretion)
  • drug/chemical toxicities
• Excessive loss of bicarbonate
  
  • impaired kidney function
  • Loss of bicarb-rich intestinal secretions (i.e. diarrhea, drainage tubes)
• Hyperchloremia
  
  • Since chloride and bicarb are both anions, increased chloride causes decreased bicarb

Question 5

Kidneys try to compensate by excreting more acid in the urine.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 5

Respiratory Acidosis

Primary excess of carbonic acid

P/C Factors: conditions that impair alveolar ventilation → increase in PCO₂

• Depression of respiratory center in medulla
  
  • i.e. head injury, drug overdose
• Lung disease
  
  • COPD, pneumonia, ARDS, pulmonary edema
• Airway obstruction
• Chest injury
• Disorders of respiratory muscles

Question 6

Treat by having people breathe in paper bag.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 6

Respiratory Alkalosis

Primary deficit of carbonic acid

P/C Factors:

• Hyperventilation
  
  • increase in respiratory rate (i.e. panic attacks, anxiety, lung disease, hypoxia, fever)

Question 7

Primary excess in base / bicarbonate.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 7

Metabolic Alkalosis

Primary excess in base / bicarbonate

P/C Factors:

• Excess gain of bicarb/alkali
  
  • Medications / IVs
• Excess loss of hydrogen ions
  
  • GI
    
    • vomiting, gastric suction → loss of hydrochloric acids + loss of chloride
  • Renal
    
    • decreased potassium levels due to diuretic therapy → kidneys excrete hydrogen while trying to save potassium.
    • Hydrogen ions shift from extracellular to intracellular because of plasma potassium-hydrogen exchange

Question 8

Primary deficit of carbonic acid.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 8

Respiratory Alkalosis

Primary deficit of carbonic acid

P/C Factors:

• Hyperventilation
  
  • increase in respiratory rate (i.e. panic attacks, anxiety, lung disease, hypoxia, fever)

Question 9

Caused by hyperchloremia.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 9

Metabolic Acidosis

Primary deficit in base / bicarbonate

P/C Factors:

• Excess metabolic acids
  
  • increased production (i.e. lactic acidosis, ketoacidosis)
  • impaired kidney function (i.e. decrease in acid excretion)
  • drug/chemical toxicities
• Excessive loss of bicarbonate
  
  • impaired kidney function
  • Loss of bicarb-rich intestinal secretions (i.e. diarrhea, drainage tubes)
• Hyperchloremia
  
  • Since chloride and bicarb are both anions, increased chloride causes decreased bicarb

Question 10

Hypoxia and hypercapnia cause CO₂ narcosis (sleepy and possibly coma).

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 10

Respiratory Acidosis

Primary excess of carbonic acid

P/C Factors: conditions that impair alveolar ventilation → increase in PCO₂

• Depression of respiratory center in medulla
  
  • i.e. head injury, drug overdose
• Lung disease
  
  • COPD, pneumonia, ARDS, pulmonary edema
• Airway obstruction
• Chest injury
• Disorders of respiratory muscles

Question 11

Hydrogen ions shift from extracellular to intracellular because of plasma potassium-hydrogen exchange.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 11

Metabolic Alkalosis

Primary excess in base / bicarbonate

P/C Factors:

• Excess gain of bicarb/alkali
  
  • Medications / IVs
• Excess loss of hydrogen ions
  
  • GI
    
    • vomiting, gastric suction → loss of hydrochloric acids + loss of chloride
  • Renal
    
    • decreased potassium levels due to diuretic therapy → kidneys excrete hydrogen while trying to save potassium.
    • Hydrogen ions shift from extracellular to intracellular because of plasma potassium-hydrogen exchange

Question 12

Primary deficit in base / bicarbonate.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 12

Metabolic Acidosis

Primary deficit in base / bicarbonate

P/C Factors:

• Excess metabolic acids
  
  • increased production (i.e. lactic acidosis, ketoacidosis)
  • impaired kidney function (i.e. decrease in acid excretion)
  • drug/chemical toxicities
• Excessive loss of bicarbonate
  
  • impaired kidney function
  • Loss of bicarb-rich intestinal secretions (i.e. diarrhea, drainage tubes)
• Hyperchloremia
  
  • Since chloride and bicarb are both anions, increased chloride causes decreased bicarb

Question 13

Primary excess of carbonic acid.

a. ) Metabolic acidosis
b. ) Metabolic alkalosis
c. ) Respiratory acidosis
d. ) Respiratory alkalosis

Answer 13

Respiratory Acidosis

Primary excess of carbonic acid

P/C Factors: conditions that impair alveolar ventilation → increase in PCO₂

• Depression of respiratory center in medulla
  
  • i.e. head injury, drug overdose
• Lung disease
  
  • COPD, pneumonia, ARDS, pulmonary edema
• Airway obstruction
• Chest injury
• Disorders of respiratory muscles

Question 14

ABG results:

pH → 7.50

pCO₂ → 40

pO₂ → 75

HCO₃ → 32

Answer 14

Uncompensated Metabolic Alkalosis

pH → 7.50* (7.35 - 7.45)

pCO₂ → 40 (35 - 45)

pO₂ → 75 (79-99)

HCO₃ → 32* (22-26)

Question 15

ABG results:

pH → 7.32

pCO₂ → 55

pO₂ → 56

HCO₃ → 26

Answer 15

Uncompensated respiratory acidosis

pH → 7.32* (7.35 - 7.45)

pCO₂ → 55* (35 - 45) increased (more acid)

pO₂ → 56* (79-99)

HCO₃ → 26 (22-26)

Question 16

ABG results:

pH → 7.23

pCO₂ → 50

pO₂ → 77

HCO₃ → 28

Answer 16

Partially Compensated Respiratory Acidosis

pH → 7.23* (7.35 - 7.45)

pCO₂ → 50* (35 - 45)

pO₂ → 77 (79-99)

HCO₃ → 28* (22-26)

Question 17

ABG results:

pH → 7.60

pCO₂ → 30

pO₂ → 80

HCO₃ → 24

Answer 17

Uncompensated Respiratory Alkalosis

pH → 7.60* (7.35 - 7.45)

pCO₂ → 30* (35 - 45)

pO₂ → 80 (79-99)

HCO₃ → 24 (22-26)

Question 18

ABG results:

pH → 7.30

pCO₂ → 32

pO₂ → 75

HCO₃ → 19

Answer 18

Partially Compensated Metabolic Acidosis

pH → 7.30* (7.35 - 7.45)

pCO₂ → 32* (35 - 45)

pO₂ → 75 (79-99)

HCO₃ → 19* (22-26)

Question 19

ABG results:

pH → 7.49

pCO₂ → 52

pO₂ → 90

HCO₃ → 33

Answer 19

Partially compensated metabolic alkalosis

pH → 7.49* (7.35 - 7.45)

pCO₂ → 52* (35 - 45) increased (more acid)

pO₂ → 90 (79-99)

HCO₃ → 33* (22-26) increased (more alkaline)

Question 20

ABG results:

pH → 7.45

pCO₂ → 50

pO₂ → 80

HCO₃ → 30

Answer 20

Compensated Metabolic Alkalosis

pH → 7.45 (7.35 - 7.45)

pCO₂ → 50* (35 - 45)

pO₂ → 80 (79-99)

HCO₃ → 30* (22-26)

Question 21

ABG results:

pH → 7.45

pCO₂ → 28

pO₂ → 75

HCO₃ → 20

Answer 21

Compensated Respiratory Alkalosis

pH → 7.45 (7.35 - 7.45)

pCO₂ → 28* (35 - 45)

pO₂ → 75 (79-99)

HCO₃ → 20* (22-26)

Question 22

ABG results:

pH → 7.35

pCO₂ → 50

pO₂ → 60

HCO₃ → 30

Answer 22

Compensated Respiratory Acidosis

pH → 7.35 (7.35 - 7.45)

pCO₂ → 50* (35 - 45)

pO₂ → 60 (79-99)

HCO₃ → 30* (22-26)

Question 23

ABG results:

pH → 7.28

pCO₂ → 39

pO₂ → 78

HCO₃ → 18

Answer 23

Uncompensated Metabolic Acidosis

pH → 7.28* (7.35 - 7.45)

pCO₂ → 39 (35 - 45)

pO₂ → 78 (79-99)

HCO₃ → 18* (22-26)