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Flashcards in Acid base disorder Deck (33):
1

Arterial Sample

Peripheral venous sample

Central Venous Sample 

  • 7.35-7.45
  • pH is usually .02-.04 units lower than in arterial, HCO3 concentration 1 to 2 meq/L higher and PCO2 is usually 3 to 8 mmHg higher
  • Usually 0.03 to 0.05 pH units lower and PCO2 is 4 ro 5 mmHg higher. Little or no incease in serum 

2

An arterial pH below the norm

less than 7.35

Acidemia

3

An arterial pH above normal range 

>7.45

Alkalemia

4

A process that tends to lower the extracellular fluid pH (H ion concentration increases). THis can be caused by a fall in serum bicarb concentration and or an elevation in PCO2

Acidosis

 

5

A process that tends to raise the extracellular fluid pH (H+ concentration is lower). This can be caused by increased serum bicarb and/or fall in PCO2

Alkalosis 

6

HCO3 <21 and/or PCO2 > 45 

Acidosis

7

HCO3 > 30 and/ or PCO2 <35

Alkalosis 

8

A disorder that causes reductions in the serum HCO3 concentration and pH 

Metabolic acidosis 

9

A disorder that causes elevations in the serum HCO3 concentration and pH

Metabolic Alkalosis

10

A disorder that causes an elevation in arterial PCO2 and a reduction in pH

Respiratory acidosis

11

A disorder that causes a reduction in arterial PCO2 and an increase in pH 

Respiratory alkalosis 

12

The presence of one of the Metabolic/Respiratory disorders with the appropriate respiratory or renal compensation for that disorder.

Simple Acid-Base Disorder

13

The presence of more than one acid-base disorder

Mixed disorder

14

Arterial pH

Normal

Alkalemia/Alkalosis

Acidemia/Acidosis

Panic values

  • 7.35-7.45
  • >7.45
  • <7.35
  • >7.55 or <7.25

15

Acidemia produces __ K+

Alkalemia produces ___ K+

pH change of 0.1 is associated with __ change in serum K+

Prolonged acidosis:?

  • Higher
  • Lower
  • 0.6 change in opposite direction
  • Renal K+ wasting 

16

Arterial pCO2

Normal 

Acidemia/acidosis

Alkalemia/alkalosis

Increased with  ____ respiratory rate or tidal volumes 

Decreased with ____ respiratory rate or tidal volume

  • 35-45 mmHg 
  • >45 mmHg
  • <35 mmHg
  • decreased 
  • increased 

17

Arterial pO2 

normal

Increased with ____ respiratory rate

Decreased with ___ respiratory rate 

Panic value?

80-100

Increased

Decreased 

<60mmHg

18

Bicarb

Arterial serum normal range

Alkalemia/Alkalosis

Acidemia/Acidosis

21-30

>30

<21

19

O2 saturation 

Normal 

Goal>__ with mechanical ventilation or > __ ambulatory 

  • 90%
  • 92%

20

In pts with metabolic acidosis, determine if the anion gap is?

Calculated by?

  • elevated >12
  • Cation - Anion 

21

Six step process for determining acid - base disorder

  1. Is the pt acidemic or alkalemic?
  2. Is the overriding disturbance respiratory or metabolic?
  3. If respiratory is it acute or chronic?
  4. If metabolic is there a high anion gap?
  5. If metabolic is there a respiratory system compensating appropriately?
  6. Is there a second metabolic disturbance present?

22

3 step for determining acid-base disorder?

  1. Is there a problem?
    1. Determine pH
  2. Establish the primary process/diagnosis (metabolic vs. respiratory)
  3. Determine compensation 

23

Respiratory vs metabolic

 

  • pH matching pCO2 (lungs)
    • pCO2 >45 or <35
    • pH 7.55 and pCO2 25 then = respiratory alkalosis 
  • pH matching HCO3- 
    • >30 or <21 and matches the pH
    • pH 7.3 and HCO3- 16 = metabolic acidosis

24

Determining compensation

  • Find the value that does not match the pH and determine if the body has attempted to correct the problem 
  • If pCO2 or HCO3- are abnormal in the opposite direction of the pH then there is compensation 
  • if pCO2 or HCO3- are not abnormal then there is no compensation
  • Complete compensation occurs when the pH is normal but the pCO2 and HCO3- are abnormal (can also be mixed)

25

Metabolic compensation

Acute and Chronic Hypercapnia

  • HCO3 increases 1 for each 10 mmHg increase in PaCO2>40 
  • HCO3- increases 3.5 for 10 mmHg increase in PaCO2 >40 

26

Metabolic compensation 

Acute/Chronic Hypocapnia

A image thumb
27

 

Metabolic acidosis

Alkalosis

Respiratory acidosis/alkalosis 

  • A disorder that causes reductions in the serum HCO3 concentration and pH.
  • A disorder that causes elevations in the serum HCO3 concentration and pH.
  • A disorder that causes an elevation in arterial PCO2 and a reduction in pH.
  • A disorder that causes a reduction in arterial PCO2 and an increase in pH.

28

Metabolic acidosis

Anion gap 

MUDPILES- Anion Gap

USED CARS Non-anion gap 

  • M-Methanol
  • U-Uremia
  • D-DKA
  • P- eraldehyde
  • I- Intoxication
  • L- Lactic acidosis
  • E- Ethylene Glycol
  • S-Salicylates

 

  • U-Uterosigmoid diversion
  • S-Saline
  • E-EtOH
  • D- Diarrhea
  • C- Carbonic anhydrase inhibitors
  • A-Alcohol, Addisons disease/Cushing
  • R- Renal Tubular Acidosis
  • S-Saline?

29

Metabolic Alkalosis

  • Alkali ingestion
  • Vomiting or NG suction
  • Fluid volume contraction
  • Hypokalemia
  • Cushings disease, glucocorticoids, mineralocorticoids, post-chronic hypercapnia
  • Massive blood transfusion (whatpreservative?)
  • Ingestion or administration of bicarb
    • Mile-alkali syndrome

30

Respiratory Acidosis

Hyperventilation 

A image thumb
31

Respiratory alkalosis

A image thumb
32

Metabolic Acidosis 

Gap or non gap?

Gap >12

Non gap 12 or less 

33

Step 3a determine gap 

In pts with metabolic acidosis, determine if anion gap is elevated

Cation-Anion 

>12 gap, metabolic acidosis