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Fubmed > Acid base > Flashcards

Acid base Flashcards

1
Q

List the symptoms of metabolic acidosis

A
  1. headache
  2. Decreased Bp
  3. Hyperkalemia
  4. muscle twitching
  5. Kussmaul respiration (compensatory hyperventilation)
  6. Nausea, vomitting, Diarrhea
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2
Q

What are the causes of metabolic acidosis?

A
  1. Diabetic ketoacidosis
  2. Severe Diarrhea (looses biocarbonate)
  3. renal failure
  4. shock
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3
Q

What is Mrs mitchells diagnosis?

A

Hyperchloremic (normal anion gap) metabolic acidosis

Complicated with hypovolemia (dehydration)

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4
Q

What are the medical results for someone with metabolic acidosis?

A

Low pH
HCO3- very low
pCO2 low
Hypokalaemia (plasma potassium level less than 3.5mmol/L)

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5
Q

What is the compensatory mechanism for metabolic acidosis?

A

compensatory hyperventilation = pCO2 low

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6
Q

What is Hypokalaemia?

A

(plasma potassium level less than 3.5mmol/L)

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7
Q

What is the name for Mrs mitchells condition the next day

A

Chronic respiratory alkalosis

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8
Q

Name the 3 compensatory mechanisms used by the body to handle PH changes?

A
  1. Physiologic buffer
  2. Pulmonary compensation
  3. Renal compensation
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9
Q

What are the the Physiologic buffers?

A

(weak acid and base salt or weak base and acid salt)

bicarbonate-carbonic acid buffering system,
• intracellular protein buffers,
• phosphate buffers in the bone.

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10
Q

What is the the Pulmonary compensation system?

A

changes in ventilation changes the partial pressure of arterial carbon dioxide (PCO2) to drive pH towards normal range.

A drop in pH, results in increased ventilation to blow off excess CO2

An increase in pH decreases ventilatory effort, which increases PCO2 and lowers pH back towards normal.

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11
Q

What is the the Renal compensation system?

A

starts when other mechanisms have been ineffective, generally after about 6 hours of sustained acidosis or alkalosis.
• In acidosis, kidneys excrete H+ in urine and retain HCO3-.
• In alkalosis, kidneys excrete HCO3-and retain H+ in the form of organic acids.

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12
Q

What is the normal blood PH range?

A

7.35 to 7.45.

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13
Q

Describe the PH and PCO2 for respiratory acidosis

A

pH is less than 7.35 and PCO2 is above 45 mm Hg

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14
Q

What causes chronic and acute respiratory acidosis?

A

occurs secondary to a chronic reduction in alveolar ventilation -Chronic COPD

Acute- Over sedation, immobility, respiratory muscle paralysis

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15
Q

Which two factors determine arterial PH in respiratory acidosis?
What is the compensatory mechanism for resp-acidosis?

A

Relationship between PCO2 and plasma HCO3

Over a period of 1 to 3 days, renal conservation of HCO3- results in an increase in pH.

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16
Q

What causes respiratory alkalosis?

A

When PCO2 is reduced, causing an increase in pH (increased alveolar ventilation, hepatic disease, pregnancy)

17
Q

What happens with the compensatory mechanism in chronic respiratory alkalosis?

A

result in mild reduction in plasma HCO3- levels to maintain a near normal or normal pH. This causes a mixed acid-base disorder.

18
Q

What is the treatment for respiratory alkalosis?

A

Fix underlying problem- anxiety

19
Q

What is Metabolic acidosis?

A

An increase in amount of absolute body acid ( excess production of acids or excessive loss of bicarbonate, sodium, and potassium)

20
Q

What can happen with potassium in sever acidosis?

A

significant overall depletion of total body potassium stores can occur
So I.V. potassium is given to patients early in treatment
(despite elevated serum potassium)

caused by K+ leaving the cell as H+ moves intracellulary as kidneys try to keep sodium)

21
Q

When does metabolic alkalosis occur?

A

when HCO3-is increased, usually as the result of excessive loss of metabolic acids. PH is above 7.45

22
Q

What are the causes of metabolic alkalosis?

A

diuretics,
prolonged vomiting,
Cushing’s syndrome

23
Q

How does chloride concentration dictate treatment for metabolic alkalosis?

A

If chloride concentration is less than 15mmol/L- condition is saline saline-responsive and treatment with 0.9% saline is needed.
Urine chloride levels above 25 mmol/L indicate nonsalineresponsive metabolic alkalosis treatment is based on addressing the underlying problem

24
Q

What is the compensatory mechanism for metabolic alkalosis?

A

alveolar hypoventilation causing a rise in PaCO2), which reduces the change in pH

25
Q

What is the compensatory mechanism for metabolic acidosis?

A

hyperventilation to decrease the arterial pCO2

26
Q

What is Mrs mitchells anion gap?

A

It is normal- 10mmol/L to 8mmol/L

27
Q

Describe the normal range for anion gap

A

Normal range 8-16 mmol/L. However, there are always unmeasurable anions, so an anion gap of less than 11 mmol/L is considered normal

28
Q

What is the equation to calculate serum anion gap?

A

(Na + K) -(Cl + HCO3)

29
Q

Name 3 agents which can increase the anion gap

A

Lactic acidosis
Diabetic ketoacidosis
Alcoholic ketoacidosis

30
Q

What is the treatment for Mrs Mitchel?l

A

IV Lactated Ringer’s • Preferred over normal saline as it corrects associated metabolic acidosis • Lactate is metabolised into bicarbonate • Potassium supplementation

31
Q

Why is Mrs mitchel’s next day so complicated?

A

Biocarbonate increases- metabolic acidosis is being corrected
PCO2 is lower than expected causing respiratory alkalaemia.
Why?
central chemoreceptors are slow in responding to increase in bicarbonate- compensatory hyperventilation is still functional.
Biocarbonate will enter brain interstitial fluid in 12-24h. This will reduce central chemoreceptor inhibition.
The recovery of pCO2 to normal lags behind the rise in the bicarbonate.

32
Q

Which percentage of water loss causes heat exhaustion, hallucination and circulator collapse plus heat stroke?

A

6% heat exhaustion
8% hallucination
10% circulatory collapse and heat stroke

33
Q

What is the normal range for PCO2?

A

35–45 mmHg
Less- hypervetilating
More- Hypoventilating

34
Q

Why does chloride increased during metabolic acidosis?

A

The lowered bicarbonate concentration, is counterbalanced by increase in plasma chloride concentration. This is why the anion gap is normal.

Fubmed (13 decks)

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