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Flashcards in ACID BASE BALANCE Deck (41)
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1

DIARRHEA

- washed out a lot of HCO3 (decrease in HCO3)
- thus generating H+ ion fix acid metabolic acidosis
- is due to INCREASE in H+ ion fixed acids
- second by DECREASE in HCO3

2

RESPIRATORY ACIDOSIS (acute)

- respiratory depression (anesthetics, morphine)
- pulmonary edema, cardiac arrest
- airway obstruction
- muscle relaxant
- sleep apnea
- chronic obstructive lung disease
- restrictive lung disease
- neuromuscular defects (MS, muscular dystrophy)
- obesity hypoventilation syndrome

3

RESPIRATORY ALKALOSIS (acute)

- anxiety
- fever
- hypoxemia
- pneumothorax ( in some cases) atelectasis pulmonary shunt increase ventilation leading to LOW arterial CO2
- ventilation- perfusion inequality
- hypotension
- high altitude

4

RESPIRATORY ACIDOSIS

- Hypoventilation
- INCREASE PaCO2
- will make the curve shift to the R
- INCREASE H+ is the cause of acidosis
- slight INCREASE HCO3 it is not part of the compensation, rather part of the disturbance (22-26)
- an increase of 10 mm Hg of CO2 will increase HCO3 by 1 mmol

5

RESPIRATORY ALKALOSIS

- HYPERVENTILATION
- that causes a DECREASE in PaCO2 (main cause)
- shift to the L
- decrease in H+ ion caused the alkalosis
- slight DECREASE in HCO3
- a decrease of PaCO2 by 10 mm Hg, the HCO3 decreases by 2 mmol

6

METABOLIC ACIDOSIS

- LACTIC ACIDOSIS (increase acid production)
- KETOACIDOSIS (increase acid production faster than the kidney produced)
- RTA type II (loss of HCO3)
- DIARRHEA (loss of HCO3)

7

METABOLIC ACIDOSIS

- decrease ability of the nephron to excrete fixed acid and thus, failure to add new HCO3 to body stores
- acute and chronic renal disease or failure
- inability to synthesize ammonia
- RTA type I

8

METABOLIC ALKALOSIS

- VOMITING
- GASTRIC SUCTIONING
- PRIMARY HYPERALDOSTERONISM, results from too much lost in H+ ions in the urine
- LOSS OF BICARBONATE-FREE FLUID (contraction alkalosis)
-maintenance:
- volume depletion
- increase aldosterone

9

METABOLIC

- main causes are HCO3 or H+

10

METABOLIC ACIDOSIS

- excess of H+ ions
- shift to the L
- BIG DECREASE in HCO3
- assuming CO2 is 40

11

METABOLIC ALKALOSIS

- caused by DECREASE IN H+ ions
- vomiting stomach contents
- BIG INCREASE IN HCO3

12

RESPIRATORY ACIDOSIS

- increase CO2
- decrease pH
- normal to increase HCO3
to compensate increase above normal HCO3

13

RESPIRATORY ALKALOSIS

- decrease CO2
- increase pH
- normal to decrease HCO3 to compensate decrease HCO3 to below normal

14

METABOLIC ACIDOSIS

- no change CO2 40 mm Hg
- decrease pH
- big decrease HCO3 to compensate increase it
- hyperventilating

15

METABOLIC ALKALOSIS

- no change in CO2 40 mm Hg
- increase pH
- big increase in HCO3 to compensate decrease it
- hypo-ventilating

16

normal values:
pH first

- 7.4
- low- acidosis
- high- alkalosis

17

normal values:
PCO2 second (RESPIRATORY COMPONENT)

- 40 mmHg
- high- acidosis
- low- alkalosis

18

normal values: (METABOLIC COMPONENT)
HCO3 last

- 24 mmol/L
- low- acidosis
- high- alkalosis

19

CONCEPT:

pH low plus PCO2 high = respiratory acidosis but if you add HCO3 low= metabolic acidosis or mixed acidotic problem VIA

20

case:
arterial components:
pH = 7.3 low acidosis
PCO2 = 30 mm Hg low rule out respiratory component, metabolic (40)
PO2 = 95 mm Hg distractors
serum:
HCO3 = 14 mEq/L low acidosis

- METABOLIC due to low PCO2 and big decrease in HCO3 ACIDOSIS due to low pH

21

case:

arterial component:
pH = 7.6 high alkalosis
PCO2 = 20 mm Hg low rule in respiratory
PO2 = 95 mm Hg
serum:
HCO3 = 18 mEq/L low acidosis

RESPIRATORY due to low PCO2 ALKALOSIS due to high pH

22

concept;

HCO3 low

23

concept:

HCO3 high > PCO2 low meaning it is more of a METABOLIC PROBLEM

24

case:

arterial components:
pH = 7.2 low acidosis
PCO2 = 80 mm Hg high rule in respiratory component
PO2 = 70 mm Hg
serum:
HCO3 = 30 mEq/L high saying no metabolic acidosis

RESPIRATORY ACIDOSIS

25

case:

arterial component:
pH = 7.6 high alkalosis
PCO2 = 52 mm Hg high rule out respiratory component hypoventilation compensation to the problem
PO2 = 70 mm Hg
serum:
HCO3 = 44 mEq/L high rule in metabolic

METABOLIC ALKALOSIS

26

arterial PCO2 = 55 mm Hg
serum HCO3 = 20 mEq/L
no pH

mixed respiratory and metabolic alkalosis
due to PCO2 is inverse to HCO3

27

CO2

- respiratory compensation

28

HCO3 (distal tubule collecting duct)

- renal compensation
if the kidney is working otherwise it would be respiratory

29

H+ ions

- increase acidosis
- to become normal shift to the L going to CO2 respiratory variable thus decrease it by hyperventilating and increase in plasma HCO3
- WINTERS FORMULA

30

H+ ions

- decrease in alkalosis
- to become normal shift to the R by hypo-ventilating and increase CO2 and decreasing HCO3 by dumping it in urine