Acid & Base Flashcards
pH 7.28
Co2 50
HCO3 > 25
what do you order?
ph: acidotic
co2: high
respiratory acidosis
lethargic,not breathing, overdose
tx: increase rate of breathing
increase rate on ventilator
narcan
Respiratory alkalosis
pH: high
co2: low
serum HCO3 low if chronic
shallow rapid respirations
decrease rate on ventilator
breathe into bag
metabolic acidosis
low serum HCO3**
if anion gap increased, the clinical situation is generally more acute
What causes increased anion gap
- DKA
- alcoholic KA
- drug or chemical anion
metabolic acidosis with normal anion gap causes
- diarrhea
- ileostomy
- renal tubular acidosis
- recovery from DKA
Treatment of metabolic acidosis with increased gap
- underlying disorder treated
- fluids resuscitation
- hco3 generally not indicated if acidosis is d/t hypoxia or dka
- hco3 indicated if significant hyperkalemia present***
Metabolic Alkalosis
HCO3: high
ph: high
compensatory CO2 rarely exceeds 55
if pCO2 is > 55 superimposed respiratory acidosis is likely
metabolic acidosis
pH: low
Bicarb: low
cdiff sets pt up for what?
metabolic acidosis because losing base
Metabolic alkalosis causes
post-hypercapnia alkalosis
NG suction
Vomiting
Diuretics
Management of Metabolic Alkalosis
- correct volume deficit with NaCl and KCL
- dc diuretics
- H2 blockers in patients with diuretics
- acetazolamide IV if volume replacement is contraindicated
Labs and diagnostics of Metabolic Alkalosis
pH >7.45 HCO3 >26 pCO2 > 45 and < 55 K and Cl decreased may see increased gap
R-O-M-E
respiratory opposite
metabolic equal
Rule of 9s
each arm 9% each leg 18% front and back chest 18% Head 9% neck 1% perineum/genitals 1%
Fluid resuscitation in burns
-4ml/kg x TBSA first 24 hours
-1/2 given first 8 hours
-other 1/2 in next 16 hours
resuscitation begins at time of burn not when they arrive to ed
