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CPR Final Exam > Intro to Acid Base Disturbances > Flashcards

Intro to Acid Base Disturbances Flashcards

1
Q

pH <7.4 and PCO2 is 35 and bicarb 12 mEq/L what would this be classified as?

A

Metabolic acidosis with respiratory compensation

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2
Q

pH >7.4 PCO2 is 28 and bicarb is 22 what would this be classified as?

A

Respiratory alkalosis with renal compensation

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3
Q

What happens to breathing in respiratory acidosis?

A

Alveolar Hypoventilation to increase PaCO2 to decrease pH

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4
Q

What happens to ventilation with respiratory alkalosis?

A

Alveolar hyperventilation to decrease PaCO2 to increase the pH

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5
Q

What is the compensatory response for Respiratory acidosis?

A

Renal bicarb reabsorption is increased

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6
Q

What is the compensatory response for Respiratory alkalosis?

A

Renal bicarb reabsorption decreases

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7
Q

Metabolic acidosis primary defect?

A

loss of bicarb or gain of H ions which decreases bicarb concentartion

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8
Q

What is the primary defect with metabolic alkalosis?

A

Gain of bicarb or loss of H ions which increases bicarb concentration

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9
Q

Compensatory response for metabolic acidosis?

A

Alveolar hyperventiation to increase pulmonary CO2 excretion which decreases PaCO2

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10
Q

Compensatory response for metabolic alkalosis?

A

Alveolar hypoventilation to decrease pulmonary CO2 excretion to increase PaCO2

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11
Q

What can cause respiratory acidosis?

A

CANS (acute)

  • CNS depression
  • Airway obstruction
  • Neuromusclular disorders
  • Severe pneumonia, embolism, edema

chronic:

  • COPD
  • anything else thats chronic impairing ventilation
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12
Q

For every __ increase in PaCO2 in an acute response bicarb should ____.

A

For every 10 mmHg increase in PaCO2 in an acute response bicarb should increase by 1.

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13
Q

For every __ increase in PaCO2 in a chronic response bicarb should ____.

A

For every 10 mmHg increase in PaCO2 in a chronic response bicarb should increase by 3.5

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14
Q

Causes of respiratory alkalosis?

A

CHAMPS

  • CNS disease —> hyperventilation
  • Hypoxia
  • Anxiety
  • Mechanical Ventilators
  • Progesterone
  • Salicylates/Sepsis
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15
Q

Respiratory alkalosis has a decreased PaCO2 what is the compensatory response for bicarb?

A

To decrease

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16
Q

For every ____ decrease in PaCO2, bicarb should acutely ____ and chronically ___.

A

For every 10 mmHg decrease in PaCO2, bicarb should acutely decreasae by 2 and chronically decrease by 5.

  • Respiratory alkalosis*
  • When you look at blood gasses you can determine if it is mixed if values dont follow these trends*
17
Q

In metabolic acidosis you have low Bicarb, what will the compensatory PaCO2 response be?

A

To decrease

18
Q

Causes of metabolic acidosis?

A
  • Decrease of bicarb or addition of an acid
  • Will result in respiratory compensation of hyperventilation to decrease PCO2
  • Renal correction increases acid titration by increaseing acid in urine and increasing bicarb regeneration
19
Q

What is normal anion gap?

A

12 mEq/L

20
Q

Clinical causes of high anion gap metabolic acidosis metabolic acidosis?

A

HAGMA —> GOLDMARK

  • Glycols
  • Oxoproline (tylenol overdose)
  • L- lactate accumulates with lactic acidosis with ischemic tissue
  • D-Lactate (appears with bowel resections and overproduction by lactobacilli after carb load)
  • Methanol
  • Aspirin
  • Renal failure, cant secrete H
  • Ketoacidosis
21
Q

What are clinical causes of Non anion gap acidosis?

A

NAGMA —> HARDUPS

  • Hyperalimentation
  • Acetazolamide
  • Renal tubular acidosis
  • Diarrhea
  • Ureterosigmoid fistula
  • Posthypocapnia
  • Spironolactone
22
Q

What is winters formula?

A
  • PaCO2= (1.5 x [bicarb] ) + 8+/- 2
23
Q

what does a high serum anion gap indicate?

A
  • There are other solutes in the plasma such as alcohols lactic acids or ketoacids
24
Q

What is renal tubular acidosis?

A
  • acidemia + normal anion gap + normal serum creatine and no diarrhea
25
Q

RTA type 1?

A
  • impaired distal hydrogen secretion
  • Impaired alpha intercalated cells
    • this is how new bicarb is generated
26
Q

RTA 4?

A
  • Lack of aldosterone or failure of kidney to respond to it
  • Hyperkalemic
  • Most common form of RTA
  • high K leads to low ammonium synthesis by Prox tubule
    • New bicarb is generated by having NH3 accept H forming NH4 to maintain acid base homeostasis
27
Q

RTA type 2?

A
  • Proximal tubules don’t reabsorb bicarb
  • Usually seen with fanconi syndrome
  • Very rare
28
Q

Metabolic alkalosis has high bicab what will the compensatory response of PaCO2 be?

A

Increase it

29
Q

What causes metabolic acidosis? (generally)

What is the compensatory response and correction?

A
  • Addition of a base (bicarb)
  • Loss of an acid (H)
  • increases pH
  • Respiratory compensation of hypoventilation occurs to increase PCO2
  • Renal correction decrease reabsorption of bicarb
  • To decrease pH
30
Q

Clinical causes of metabolic alkalosis?

A

CLEVER PD

  • Contraction (selective loss NaCl in urine, keep bicarb)
  • Licorice
  • Endocrine (Cushings, Conn)
  • Vomiting (lose HCl)
  • Excess alkali
  • Refeeding alkalosis
  • Post-hypercapnia
  • Diuretics (vol. contract, K loss)
31
Q

In metabolic alkalosis we are looking for Chloride responsive or chloride resistance. What does that mean?

A
  • Chloride responsive: causes include vomiting,diuretics, nasogastric suction, villous adenoma
    • spot urince Cl should be less than 10 mEq/L since kidney is conserving Cl
    • Tx with normal saline should fix disturbance
  • Chloride resistant: distal exchange site stimulation by aldosterone resulting in increased H and K excretion in exchange for resporption of Na as NaHCO3, ongoing diuretic use/abuse
    • Spot urine high Cl despite fact kidney should be conserving Cl
    • Tx cause of H loss to treat alkalosis
32
Q

Acute respiratory acidosis Sx?

A
  • Headache
  • Confusion
  • Anxiety
  • Drowsiness
  • Stupor tremors
  • COnvulsions
33
Q

Chronic respiratory acidosis sx?

A
  • Pay be well tolerated as it is slowly developing and stable
  • Patients may have memory loss
  • sleep disturbance
  • daytime sleepiness
  • personality changes
34
Q

Acute respiratory alkalosis sx?

A
  • Light headed
  • Confusion
  • Peripheral and circumoral paresthesias
  • Cramps
  • Syncope
  • tachypnea or hyperpnea
  • carpopedal spasm due to hypocalcemia
35
Q

Chronic respiratory alkalosis sx?

A
  • usually asymptomatic no distinctive signs
36
Q

What type of metabolic dysfunction is a loop diuretic assoc. with?

A

Metabolic alkalosis

37
Q

What acid base disturbance does COPD assoc. with?

A

Chronic respiratory acidosis

CPR Final Exam (16 decks)

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