ACID BASE

Question 1

Function of Acid-Base

Answer 1

Homeostasis
Body fluids
Kidneys
Lungs

Question 2

How do we measure acid-base?

Answer 2

PH

- Normal is 7.35-7.45

Question 3

Acid- Base Buffer

Answer 3

Carbon Dioxide mixes with water to form carbonic acid

Bicarbonate and hydrogen ions mix to form carbonic acid

Both processes require carbonic anhydrase to occur

Question 4

CO2 is controlled by what

Answer 4

Respiratory

Question 5

HCO3- is controlled by what

Answer 5

Metabolic

Question 6

Breathing controls what acid

Answer 6

CO2

Question 7

RR less than 12 promotes?

Answer 7

increased CO2

Question 8

RR greater than 20 promotes?

Answer 8

decreased CO2

Question 9

How fast does the respiratory system respond to change?

Answer 9

Immediately but effect is weak

Question 10

The kidneys primarily control acid-base balance through the retention or excretion of two substances

Answer 10

Hydrogen ions

Bicarbonate ions

Question 11

Renal System responds how?

Answer 11

• it takes hours to days

- very effective though

Question 12

How do we figure out what acid-base status is in real world?

Answer 12

Arterial Blood Gas (ABG)

Sample of blood taken from an artery
Most common radial or femoral

Run through a machine for various values

Question 13

Low pH
High Co2
Low Hco3

Answer 13

Acidic Resp is opposite and metabolic is equal

Question 14

High pH
low Co2
High HCO3

Answer 14

Alkaline

Question 15

Compensation

Answer 15

If ph is below 7.35 body will compensate to 7.31-7.35
If pH is higher than 7.45 body will compensate to 7.41-7.45
- 7.4 is midpoint

Question 16

Uncompensated

Answer 16

When one resp or metabolic is abnomal and pH is abnormal

Question 17

Partially Compensated

Answer 17

When all 3 are abnormal

Question 18

Compensated

Answer 18

when both bicarb and resp are abnormal but pH is normal

Question 19

Metabolic Acidosis Causes

Answer 19

Excess carbonic acid production or bicarbonate deficit with multiple causes:
- DKA and Lactic Acid accumulation from not enough oxygen in tissues
-Severe Diarrhea: Dehydration, can lead to shock or lactic acid buildup
Stool contains bicarb and severe diarhhea means prolonged loss of bicarbonate
- Renal disease: decrease production of bicarb

Question 20

M. Acidosis Compensation

Answer 20

If there isn’t a problem with renal function, then the kidneys will attempt to produce more bicarbonate

However, usually the bicarbonate deficit exceeds the amount the kidneys can produce, so it is not enough.

• Respiratory compensates with hyperventilation but is weak

Question 21

S/s of M. Acidosis

Answer 21

Kussmaul’s respirations?

Lethargy, fatigue, coma

Hypertension, dysrhythmias
- Hyperkalemia since potassium exchanges with hydorgen ions

Question 22

M. Acidosis Tx

Answer 22

Treat the underlying cause

• If the kidneys are impaired, then hemodialysis is a priority
• If the patient is in a state of DKA, then insulin administration is a priority
• If the patient is in a type of shock state, then fluid replacement or other shock treatment is a priority

Question 23

What can be done for hyperkalemia with M. Acidosis?

Answer 23

Insulin and D5, loop diuretics like fuerosimde, sodium polyestrene, and calcium gluconate

Question 24

Metabolic Alkalosis Causes?

Answer 24

• Loss of hydrochloric acid from vomiting
• Gastric suctioning
• Bicarb gain esp in pts with renal insuffiency

Question 25

M. Alkalosis Comp

Answer 25

Renal excretion of bicarbonate Respiratory, decrease in respiratory rate - Resp effect first

Question 26

M. Alkalosis S/S

Answer 26

- hyperactive reflexes - Parenthesia - tetany - seizures - Resp depression

Question 27

Tx for M. Alkalosis

Answer 27

-Adequate hydration Good for prolonged vomiting or gastric suction -0.9% sodium chloride -Arginine hydrochloride Raises chloride levels which are reduced from gastric suction or gastric loss -A diuretic: Diamox (acetazolamide) Carbonic anhydrase inhibitor, why would this help? Carbonic anhydrase is the compnenet in the buffer system that causes bicarbonate to turn into carbonic acid If it is inhibited, then bicarbonate is prevented from turning into carbonic acid and instead gets excreted.

Question 28

Resp Acidosis CAuse

Answer 28

-Hypoventilation: Respirations < _12_ per minute? -Respiratory Failure Injury to the Medulla What is this? CNS resp control center Overdose of what types of medications? Opiods, benzos, anything with sedative effects

Question 29

Resp Acidosis Comp

Answer 29

Unlike metabolic processes where the kidneys can still try to compensate Respiratory acid-base imbalances are due to impaired respiratory function Compensation is only through renal compensation Kidneys will retain bicarbonate ions or excrete hydrogen ions Slow process to start

Question 30

Resp Acidosis S/S

Answer 30

``` Mental status changes may occur first clinically Irritability Disorientation Lethargy Coma Headache ``` Tachycardia

Question 31

TX for obstructive breathing condition with Resp Acidosis

Answer 31

Priority is to treat the underlying cause or what process is causing the reduced respiratory rate For an obstructive type of breathing condition Bi-level positive airway pressure (BiPAP) Mechanical ventilation in more severe cases

Question 32

TX for sedative med or overdoes that causes resp acidosis

Answer 32

Antidote for offending agent, what is an example? | Naloxone (Narcan) for opiod overdose

Question 33

Other interventions to improve breathing depth and quality

Answer 33

Oxygen administration Keeping the head of bed elevated Antibiotics if pneumonia is involved

Question 34

Resp Akalosis Cause

Answer 34

Acid deficit caused by hyperventilation or pulmonary disorders

Question 35

What are some conditions that cause hyperventilation's

Answer 35

``` Anxiety Fever Pain Trauma Anemia Asthma Pulmonary embolism Cerebrovascular accident or stroke ```

Question 36

Resp Alkalosis Comp

Answer 36

Bicarbonate shifts into cells in exchange for Chloride ions If alkalosis persists renal excretion of bicarbonate can happen

Question 37

Resp Akalosis S/s

Answer 37

Neuromuscular symptoms Paresthesia, dizziness, vertigo, tetany Cardiovascular symptoms Tachycardia, dysrhythmias, excessive diaphoresis

Question 38

Resp Alkalosis Tx

Answer 38

Priority is fixing underlying cause -If in pain or anxiety, an intervention that targets pain or anxiety - If due to asthma, a bronchodilator - If due to anemia, restoration of hemoglobin