Acid/Base Disorders Flashcards
1
Q
acidity is determined by the ____ ion concentration
A
H+
2
Q
degree of acidity is described by the ____
A
pH
3
Q
dissociation of acid/base pairs is dependent on ____ and ____
A
- dissociation constant 2. relative concentration of acid/base in solution
4
Q
normal pH
A
7.4 (7.35 - 7.45)
5
Q
normal PaCO2
A
40 (35-45)
6
Q
normal HCO3-
A
24 (22-26)
7
Q
effect of increase PaCO2
A
increase in acid content (decrease pH)
8
Q
effects of decreased PaCO2
A
decrease in acid content (increase pH)
9
Q
effects of increased HCO3
A
increase in base content (increase pH)
10
Q
effected of decreased HCO3
A
decrease in base content (decrease pH)
11
Q
pH is determined by the ratio of what?
A
HCO3 and PaCO2
12
Q
Key extracellular buffers
A
carbonic acid/bicarb plasma proteins hemoglobin phosphates
13
Q
What part is under respiratory control?
A
CO2
14
Q
What part is under kidney control?
A
H+ and HCO3-
15
Q
How much volatile acids are produced daily and excreted as CO2?
A
12,000 - 15,000 mEq
16
Q
How are volatile gases eliminated?
A
as CO2 in lungs
17
Q
How are nonvolatile acids eliminated?
A
kidneys
18
Q
How much non-volatile acids ae produced daily and excreted by kidneys?
A
1 mEq/kg/day
4,500 mEq bicarb delivered to nephron and must be reabsorbed
19
Q
the pH of body fluids is determined by what (3)
A
- amount of acid produced
- buffering capacity
- acid excretion by lungs and kidneys
20
Q
What can be altered in respiratory system to accommodate acute changes in pH?
A
respirtory rate
tidal volume
21
Q
What can be altered in kidney system to adjust pH?
A
change in bicarb
New HCO3 through ammoniagenesis
22
Q
Are the lungs or kidney more responsive to acute acid/base changes?
A
lungs!
23
Q
t/f the body will try to normalize pH and will return to normal pH
A
False!
NEVER return to normal pH
**except chronic respiratory alkalosis
24
Q
Which compensation is faster? respiratory or renal?
A
Respiratory! (hours)
renal (days)
25
what equation is used to measure respiratory compensation?
Winters formula
26
Is insulin resistance a consequence of acidemia or alkalemia?
acidemia
27
Is impaired cardiac contractility a consequence of acidemia or alkalemia?
acidemia
28
Is bradycardia and heart block a consequence of acidemia or alkalemia?
acidemia
29
Is increase pulmonary vascular resistance a consequence of acidemia or alkalemia?
acidemia
30
Is hyperkalemia a consequence of acidemia or alkalemia?
acidemia
31
Is increased protein degradation a consequence of acidemia or alkalemia?
acidemia
32
Is reduction in ventricular fib threshold a consequence of acidemia or alkalemia?
acidmeia
33
Is arteriolar vasoconstriction a consequence of acidemia or alkalemia?
alkalemia
34
Is reduced coronary blood flow a consequence of acidemia or alkalemia?
alkalemia
35
Is reduced cerebral blood flow a consequence of acidemia or alkalemia?
alkalemia
36
Is hypokalemia a consequence of acidemia or alkalemia?
alkalemia
37
Is hypomagnesemia a consequence of acidemia or alkalemia?
alkalemia
38
Is hypophosphatemia a consequence of acidemia or alkalemia?
alkalemia
39
Is hypocalcimia a consequence of acidemia or alkalemia?
alkalemia
40
Is seziures, lethargy, delirium a consequence of acidemia or alkalemia?
alkalemia
41
Where do you get an arterial blood gas sample?
Radial artery
42
Potential complications of getting arterial blood gas (ABG)
- site pain
- hematoma
- infection
- arterial occlusion or thrombosis
43
Potential limitations with collection and analysis of ABG
sample should be drawn, chilled and analyzed within 30 mins
44
Acidemic pH
\<7.35
45
alkalemic pH
\>7.45
46
PaCO2 of respiratory acidosis
\>40
47
PaCO2 of respiratory alkalosis
\<40
48
HCO3- of metabolic acidosis
\<22
49
HCO3- of metabolic alkalosis
\>26
50
What acromyn do you use for acute respiratoyr acidosis?
CAPPHN
51
Acute respiratory acidosis causes (acronym)
**C**NS depression
**A**irway obstruction
**P**ulmonary edema
**P**neumonia
**H**emo/pneumothorax
**N**euromuscular
\*\*anything causing hypoventilation
52
3 overall causes of acute respiratory acidosis
- inadequate minute ventilation
- increased dead space ventilation (COPD)
- increased carb metabolism (TPN)
53
Clinical presentation of acute respiratory acidosis
- altered mental status
- headache
- papilledema
- focal paresis
- seizures
- coma
54
treatment of acute respiratory acidosis
- restore ventilation
- oxygen
55
Do you give bicarb to acute respiratory acidosis?
not routinely necessay
may precipiate metabolic alkalosis or suppres patient ability to breath
56
What acronym do you use for acute respiratory alkalosis?
CHAMPS
57
CAPPHN - C
CNS depression
COPD
(acute resp acidosis)
58
CAPPHN - A
Airway obstruction
Apnea
ARDS
(acute resp acidosis)
59
CAPPHN - P x 2
pulmonary edema
pneumonia
(acute resp acidosis)
60
CAPPHN - H
hemo/pneumonthorax
Hypnotics/sedative
(acute resp acidosis)
61
CAPPHN - N
Neuromuscular (acute resp acidosis)
62
CHAMPS - C
CNS disease (acute resp alkalosis)
63
CHAMPS - H
hypocapnia
Hepatic encephalopathy
Hypoxia
(acute resp alkalosis)
64
CHAMPS - A
Anxiety
altitude sickness
(acute resp alkalosis)
65
CHAMPS - M
mechanical ventilation (acute resp alkalosis)
66
CHAMPS - P
progesterone/PE
pregnancy
(acute resp alkalosis)
67
CHAMPS - S
salicylate/sepsis (acute resp alkalosis)
68
Causes of acute respiratory alkalosis (acronym)
**C**NS disease
**H**ypocapnia
**A**nxiety
**M**echanical ventilation
**P**rogesterone/PE
**S**alicylate
69
treatment of respiratory alkalosis
treat underlying condition
- slow down breathing (analgesia, anxiolytics)
- correct hypoxemia
- if ventilated, make adjustments (TV or RR)
70
T/F with compensatory responses the body will return to normal pH
False! try to normalize pH, never return to normal
EXCEPT chronic resp alkalosis
71
Compensaory mechanisms are dependent on appropriately working _____ and \_\_\_\_\_
kidneys
lungs
72
Is respirator or renal compensation quicker?
respiratory (hours)
renal (days
73
3 main causes of chronic respiratory acidosis
- chronic lung disease
- chronic neuromuscular disease
- chronic respiratory center depression
74
Chronic lung disease causes of chronic respiratory acidosis
COPD
pulmonary fibrosis
interstitial pulmonary disease
75
chronic neuromuscular disease causes of chronic respiratory acidosis
Guillian Barre
ALS
Myasthenia Gravis
76
Management of chronic respiratory acidosis
- clear secretions
- relieve bronchospasm (bronchodilators, steroids)
- aggressively treat CHF or pulm infections
- avoid excessive O2 delivery
77
Do you use winters formula in respiratory or metabolic disorder?
metabolic
78
After winters equation, if measured PaCO2 is \< than expected then what?
co-existing respiratory alkalosis
79
After winters equation, if measured PaCO2 is \> than expected then what?
co-exisiting respiratory acidosis
80
A high anion gap means here is a loss of _____ and indicates \_\_\_\_\_
Bicarb
acidosis
81
When there is an ______ in acid, there is an increase in anion gap because _____ is decrease in response to _____ the excess acid
increase
bicarb
buffer
82
Acronym for increase anion gap
MUDPILERS
83
MUDPILERS - M
Methanol/metformin (increased AG)
84
MUDPILERS - U
uremia (increased AG)
85
MUDPILERS - D
DKA (increased AG)
86
MUDPILERS - P
Paraldehyde (incrased AG)
87
MUDPILERS - I
isoniazid/iron
| (increased AG)
88
MUDPILERS - L
Lactic acid (increased AG)
89
MUDPILERS - E
ethylene glycol/ethanol (increased AG)
90
MUDPILERS - R
Renal failure (increased AG)
91
MUDPILERS - S
Salicylates (increased AG)
92
limitations of anion gap
hypoalbuminemia can affect observed AG
93
Measured AG and hypoalbuminemia
decrease 3 mmol for ever 1 g/dL decrease in albumin
94
acronym for non-anion gap
HARDUPS
95
HARDUPS - H
hyperalimentation
HCl admin
(non-AG)
96
HARDUPS - A
acetazolamide (non-AG)
97
HARDUPS - R
Renal tubular acidosis
renal bicarb loss
CAIs
(non-AG)
98
HARDUPS - D
diarrhea (non-AG)
99
HARDUPS - U
uretero-pelvic shunt
ureteral diversion
(non-AG)
100
HARDUPS - P
post-hypocapnia
101
HARDUPS - S
spironolactone (non-AG)
102
What is delta gap used for?
assist determination for mixed acid/base disorders
103
Delta gap + measured HCO3 = ____ or higher then what is occuring?
28
underlying concurrent metabolic alkalosis
104
delta gap + measured HCO3 \< ____ then what is occuring?
20
underlying concurrent nongap metabolic acidosis
105
If there is an underlying nongap metabolic acidosis what could be the causes?
GI loss bicarb (diarrhea)
renal loss bicarb (RTA, ATN, hypoaldosterone)
dilutional (post resuscitation)
106
Metabolic acidosis treatment
- correct the cause
- renal loss: give bicarb (not in AG acidosis)
- control diarrhea
- DKA: fluids, insulin
- lactic acidosis: improve hemodynamics
- intoxication: treat
107
Would you use bicarb in metabolic acidosis?
Yes, but not in anion gap acidosis
108
acronym for metabolic alkalosis
CLEVERPD
109
CLEVERPD - C
contraction (metabolic alkalosis)
110
CLEVERPD - L
licorice (metabolic alkalosis)
111
CLEVERPD - E x 2
excess alkali
endocrine (Conn/cushing)
(metabolic alkalosis)
112
CLEVERPD - V
vomiting (metabolic alkalosis)
113
CLEVERPD - R
refeeding (metabolic alkalosis)
114
CLEVERPD - P
post-hypercapnia (metabolic alkalosis)
115
CLEVERPD - D
diuretics (metabolic alkalosis)
116
metabolic alkalosis causes (acronym)
**C**ontraction
**L**icorice
**E**ndocrine (conn/cushing)
**V**omiting
**E**xcess alkali
**R**efeeding
**P**ost-hypercapnia
**D**iuretics
117
Non-anion gap causes (acronym)
**H**yperalimentation/HCl admin
**A**cetazolamide
**R**enal bicarb loss/renal tubular acidosis
**D**iarrhea
**U**retero-pelvic shunt/diversion
**P**ost-hypocapnia
**S**pironolactone
118
Anion gap causes (acronym)
**M**ethanol/metformin
**U**remia
* *D**KA
* *P**araldehyde
**I**soniazide/irone
**L**actic acid
**E**thylene glycol/ethanol
**R**enal failure
**S**alicylates
119
metabolic alkalosis treatment
treat underlying disease
- rehydrate with normal saline with K
- if excess mineralocorticoid acvitiy: aldosterone inhibition (spironolactone, amiloride, triamterene)
