Acid-Base Disorders

Question 1

PCO2

Answer 1

partial plasma for CO2

Question 2

what values are found in an ABG?

Answer 2

pH, HCO3, PCO2

Question 3

when do you do the Allen test?

Answer 3

prior to drawing blood

Question 4

why do we order an ABG?

Answer 4

assess respiratory (ventilation) and metabolic (renal) and electrolyte homeostasis

• manage ventilator
• pre-op assessment
• acute/critical illness assessment

Question 5

why do we use radial instead of femoral artery?

Answer 5

it is a cleaner site

Question 6

what does the allen test accomplish?

Answer 6

identifies if the ulnar artery will compensate for the radial artery if you block it while taking the sample
-ensures patency

Question 7

what kind of test tube will you use to get a blood gas?

Answer 7

green top (heparin)

Question 8

how quickly should your blood gas sample get to the lab?

Answer 8

ASAP or place on ice

Question 9

one or two sticks?

Answer 9

you may use lidocaine to numb the area prior to drawing blood from the RA

Question 10

positive Allen test means

Answer 10

ulnar artery is not patent and you cannot use that hand (7-10 seconds return)

Question 11

contraindications for RA

Answer 11

no palpable pulse
cellulitis or open infection
AV fistula
severe coagulopathy
positive Allen test

Question 12

what are the potential complications of drawing a blood gas?

Answer 12

arterial occlusion

penetration of other important structures nearby

Question 13

what is the normal pH of arterial blood?

Answer 13

7.4

Question 14

what is the normal pH of venous blood and interstitial fluid

Answer 14

7.35 (has extra CO2 released from nearby tissues that makes it more acidic)

Question 15

what is the normal pH of intracellular fluid

Answer 15

estimated to be between 6.0-7.4

Question 16

what is considered acidosis?

Answer 16

<7.35

Question 17

what is considered alkalosis?

Answer 17

> 7.45

Question 18

what are the lower and upper limits of pH that support life?

Answer 18

6.8<8.0 (more than a few hours at the high and low end will end life)

Question 19

where is Hydrogen found most?

Answer 19

intracellular (which makes cells more acidic)

Question 20

what is the alkaline substance in the body?

Answer 20

HCO3

Question 21

what is the acidic substance in the body?

Answer 21

H+ and CO2 (H2CO3)

Question 22

how does the body hold onto CO2?

Answer 22

breathing slower (found in alkaline patients)

Question 23

where is bicarb manufactured?

Answer 23

kidney (slower than the lungs when it comes to compensation)

Question 24

which organ responds first when pH becomes out of balance?

Answer 24

lungs

Question 25

which organ controls retention and secretion of H+

Answer 25

kidney

Question 26

what are the normal values for bicarb?

Answer 26

22-26 mEq/L

Question 27

what is the alkalotic value of bicarb?

Answer 27

>26 | -metabolic alkalosis

Question 28

what is the acidic value of bicarb?

Answer 28

<22 | -metabolic acidosis

Question 29

what are the normal values of PCO2?

Answer 29

35-45 mm/Hg

Question 30

what is the alkalotic value of PCO2

Answer 30

<35 | -respiratory alkalosis

Question 31

what is the acidodic value of PCO2

Answer 31

>45 | -respiratory acidosis

Question 32

metabolic acidosis

Answer 32

acidosis caused by a primary decrease in bicarb | -diarrhea (loss of HCO3 in feces)

Question 33

metabolic alkalosis

Answer 33

caused by a primary increase in bicarb concentration | -drug overconsumption of HCO3 (overcorrecting in renal disease)

Question 34

respiratory acidosis

Answer 34

caused by an increase in PCO2 from a respiratory disturbance | -hypoventilation (drug use)

Question 35

respiratory alkalosis

Answer 35

caused by a decrease in PCOz from a respiratory disturbance | -hyperventilation (anxiety)

Question 36

what is the time frame of the renal compensatory response?

Answer 36

several hours to 3-5 days

Question 37

what is the time frame of the respiratory compensatory response?

Answer 37

minutes to max in several hours

Question 38

SOB can also be called

Answer 38

hyperventilation (compensatory response of acidosis)

Question 39

how much will ventilation increase in acidosis?

Answer 39

4-5 times normal

Question 40

how much will ventilation slow down in alkalosis?

Answer 40

will slow but not as significantly

Question 41

COPD who are former smokers are in a chronic state of

Answer 41

respiratory acidosis

Question 42

what is metabolic compensation in acidosis?

Answer 42

reabsorb all filtered HCO3 produce new HCO3 which is added back into the extracellular fluid secrete H+ -net effect is lowered extracellular H+

Question 43

what is metabolic compensation in alkalosis

Answer 43

increase secretion of HCO3 | ***most of the compensation is respiratory***

Question 44

what is a chem 7

Answer 44

BMP

Question 45

what CO2 does the BMP come with?

Answer 45

not the same as a ABG

Question 46

what is the formula to calculate anion gap?

Answer 46

Na - Cl+HCO3 (from blood gas)

Question 47

what does elevated anion gap indicate?

Answer 47

metabolic acidosis

Question 48

what is the Delta gap?

Answer 48

excess anion gap | AG-12 +HCO3

Question 49

what does <23 delta gap indicate?

Answer 49

metabolic acidosis

Question 50

what does >30 delta gap indicate?

Answer 50

metabolic alkalosis