Acid-Base Disorder Flashcards by Kathryn Cannaday

Acid/Base

What is the normal pH from arterial blood gas?

7.35-7.45

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Acid/Base

What is the normal PaCO2 from arterial blood gas?

35-45

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Acid/Base

What is the normal PaO2 from arterial blood gas?

80+

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Acid/Base

What is the normal HCO3- from arterial blood gas?

22-26

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Acid/Base

What is the normal BE from arterial blood gas?

-2 to +2

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Acid/Base

What are the homeostasis mechanisms for acid/bases?

buffers
lungs
kidneys

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Acid/Base

What buffers does the body have to maintain acid/base homeostatsis?

bicarb (HCO3-)
carbonic acid
phosphate
proteins

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Acid/Base

What is the mechanism for metabolic acidosis/alkalosis?

bicarb (HCO3-)
too much= acidosis, too little= alkalosis

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Acid/Base

What is the compensatory mechanism for metabolic acidosis?

decreasing paCO2 via increased respiratory rate (expelling CO2)

metabolic acidosis= too much bicard (HCO3-)

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Acid/Base

What is the compensatory mechanism for metabolic alkalosis?

increasing paCO2 via respiration changes

metabolic alkalosis= too much bicarb (HCO3-)

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Acid/Base

What is the mechanism for respiratory acidosis/alkalosis?

CO2
acidosis= too much CO2, alkalosis= too little CO2

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Acid/Base

What is the compensatory mechanism for respiratory acidosis?

increasing bicarb (HCO3-)

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Acid/Base

What is the compensatory mechanism for respiratory alkalosis?

decreasing bicarb (HCO3-)

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Acid/Base

How is anion gap calculated for metabolic acidosis?

AG= (Na+) - (Cl- + HCO3-)
all drawn from BMP

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Acid/Base

How is an anion gap determined for metabolic acidosis?

AG > 12 mEq/L

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Acid/Base

How can albumin effect the anion gap?

low serum albumin with decrease the apparent anion gap (mask the gap) so use: AG (corrected)= AG + 2.5(4.5-[albumin])

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Acid/Base

What are the causes of anion gap metabolic acidosis?

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Methanol
Uremia
DKA (most common)
Paraldehyde
Iron/isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

MUDPILES

Acid/Base

What are the causes of non-anion gap metabolic acidosis?

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Ureteral diversions
Saline infusions
Exogenous acid
Diarrhea
Carbonic anhydrase inhibitors
Adrenal insufficiency
Renal tubular acidosis

USEDCAR

Acid/Base

What are the signs and symptoms of metabolic acidosis?

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hyperventilation
tachycardia
decreased cardiac output, hypotension
anorexia, nausea, vomiting
hyperglycemia
increased protein catabolism
hyperkalemia

Acid/Base

What is the treatment for metabolic acidosis?

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treat underlying cause
normalize fluid status, oxygenation, perfusion, and cardiac output
administer sodium bicard or THAM
adjust ventilator, lower CO2
add acetate (base) to TPN

Acid/Base

What is the dosing of sodium bicarbonate for the treatment of metabolic acidosis?

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HCO3- (mEq) deficit= 0.5 x weight (kg) x [24- serum HCO3- (mEq/L)]
Give 1/4-1/2 of dose initially over several hours, then give 1/2 dose as continuous IV over next 24 hours

Acid/Base

What is the strength in 1 amp of sodium bicarbonate?

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50mEq= 50mL

Acid/Base

What are the administration options for sodium bicarbonate?

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D5W has no Na+ and 150 mEq may be added
1/2NS has 77 mEq of Na+ so 100mEq may be added
NS and LR are not generally used because Na+ /L will be exceeded and minimal sodium bicarbonate can be added

NTE 180 mEq/L of Na+ in IV fluids

Acid/Base

What are the monitoring parameters while on sodium bicarbonate?

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pH (goal 7.2 or greater- AVOID overcorrection!)
bicarb (goal 10-15 mEq/L- AVOID overcorrection!)
Na+
K+
clinical status

# Acid/Base What is the use of tromethamine (THAM) in metabolic acidosis?

patients that cannot tolerate sodium load from sodium bicarbonate

# Acid/Base What is the dosing of tromethamine (THAM)?

THAM (mL)= weight (kg) x base deficit (mEq/L) x 1.1 *given IV over 1 hour*

# Acid/Base What are the monitoring parameters while of tromethamine (THAM)?

- pH - bicarb - K+ - blood glucose- may cause hypoglycemia - clinical status | DO NOT OVERCORRECT!

# Acid/Base What are the causes of metabolic alkalosis?

- Diuretics/diuresis - Iatragenic gain of bicarb - TPN - Contraction alkalosis - Hypokalemia - Emesis - Suctioning | DITCHES

# Acid/Base What are the signs/symptoms of metabolic alkalosis?

- arterior constriction - reduction in coronary blood flow - hypokalemia, tetany - seizures, delirium

# Acid/Base What are the classifications of metabolic alkalosis?

- saline responsive (most common), Cl- (urine) < 10-15 mEq/L - non-saline responsive, Cl- > 25 mEq/L

# Acid/Base What is the treatment for saline responsive metabolic alkalosis?

- replace volume= NS = 20-40 mEq KCl/L @ 100-200 mL/h - acetazolamide - potassium supplementation

# Acid/Base What is the treatment for non-saline responsive metabolic alkalosis?

- spironolactone (aldosterone inhibitor) - ACE inhibitor - sodium restriction - potassium supplementation | *caused due to mineralcorticoid excess and potassium imbalance*

# Acid/Base What is the dosing of Acetazolamide?

250-500 mg IV push 1 x dose over 3 mins, may repeat as needed | also avaliable PO

# Acid/Base What drug for acid/base disorder must be avoided in patients with sulfa allergy?

acetazolamide

# Acid/Base What are the monitoring parameters while on acetazolamide?

- pH (goal= 7.4 or less) - bicarb (goal= maintain 20 mEq/L or greater) - chloride - Cl- (urine) - clinical status | *AVOID OVERCORRECTION*

# Acid/Base What is contraction alkalosis?

excessive fluid loss (specifically loss of H+, K+, Cl-), typically caused by diuretics but amount of bicarb stays the same

# Acid/Base What are the causes of respiratory acidosis?

*hypoventilation* - CNS depression - medications (sedatives, opioids) - neuromuscular disorders - chest wall abnormalities - disorders affecting gas exchange - airway obstruction

# Acid/Base What are the signs/symptoms of respiratory acidosis?

- mental status changes - seizures - headache - blurry vision - anxiety -> tremors, delirium, coma - increased cerebral blood flow - increased CSF pressure

# Acid/Base What is the treatment for respiratory acidosis?

- treat underlying disorder - supply oxygen - corticosteroids/bronchodialators - mechanical ventilation

# Acid/Base What are the causes of respiratory alkalosis?

*hyperventilation* - often induced by stressor= anxiety, pain - hypoxemia, pulmonary embolism - infection - pneumonia - sepsis

# Acid/Base What are the signs/symptoms of respiratory alkalosis?

- cerebral vasoconstriction - lightheadedness - confusion - syncope - paresthesias, numbness around mouth - somatic symptoms (chest tightness, dyspnea)

# Acid/Base What is the treatment for respiratory alkalosis?

- treat underlying cause - reassurance - brown paper bag - breath holding techniques - mechanical ventilation

Acid-Base Disorder Flashcards

(42 cards)