Acid Base (exam 3) Flashcards by Olivia Hofer

hydrogen homeostasis

complex interactions between respirator and renal systems
compensate to maintain normal pH

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an acid ________ protons

a base __________ protons

donates

accepts

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normal pH is

7.35-7.45

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buffering

ability of a weak acid and its corresponding base to resist change in pH

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primary buffer in humans

carbonic acid (H2CO3)
bicarbonate (HCO3)

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when pH increases, _________ increases and the body is more _____________

bicarbonate

basic

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when pH decreases, ___________ increases and the body is more _______________

arterial partial pressure of carbon dioxide

acidic

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metabolic disorders primary disturbance is

plasma bicarbonate (Kidneys)

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respiratory disorders primary disturbance is

arterial partial pressure of carbon dioxide (lungs)

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changes in the respiratory system occur ______________ and changes in ________________ allow for increased or decreased excretion of CO2

quickly

rate and depth of ventilation

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respiratory acid (PCO2)

reflects the amount of carbonic acid in the body
obtained from arterial blood gas

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changes in the metabolic system occurs _____________ and changes in ____________ allow for increased/decreased concentrations of HCO3

slowly

filtration and reabsorption

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metabolic base

venous CO2
reflects amount of HCO3 in body
obtained from venous chemistry panel

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arterial blood gas

pH
PCO2
PaO2
HCO3
base excess

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normal value of pH

7.4

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normal value of oxygen

80-100 mm Hg

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normal value of oxygen saturation

over 93%

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normal value of carbon dioxide

40 mm Hg

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normal value of bicarbonate

24 mmol/L

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normal value of serum anion gap

9 mmol/L

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normal value of base excess

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respiratory acidosis

increased PCO2
decreased RR or tidal volume

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compensatory mechanism for respiratory acidosis

increased bicarbonate

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main clinical sign of respiratory acidosis

altered mental status

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severe respiratory acidosis signs

abnormal behavior seizures stupor coma can mimic stroke of CNS tumors

treatment of respiratory acidosis

correct and treat underlying cause/illness correct hypoxia with inhaled oxygen bronchodilators

when treating respiratory acidosis, avoid _______________ because it can cause _____________

IV sodium bicarbonate cerebral vasoconstriction and ischemia

respiratory alkalosis

result of decreased PCO2 increased RR or tidal volume

compensatory mechanism for respiratory alkalosis

decreased bicarbonate

clinical presentation of respiratory alkalosis

usually asymptomatic hyperventilation light headedness confusion muscle cramps and tetany NV

cause of respiratory alkalosis

central stimulation hypoxemia/tissue hypoxemia

treatment of respiratory alkalosis

usually self limiting slow breathing to increase CO2 breath in a bag

metabolic acidosis is a result of

decreased bicarbonate

metabolic acidosis is further classified into

anion gap or non-anion gap

serum anion gap metabolic acidosis

excess acid present in the body

non-serum anion gap metabolic acidosis

abnormal loss/handling of bicarbonate

serum anion gap is calculated by

venous blood draw

serum anion gap =

Na - (Cl + CO2)

compensatory mechanism for metabolic acidosis

decrease PCO2 by increasing RR

clinical presentation of metabolic acidosis

usually asymptomatic if severe: flushing rapid HR coma N/V hyperventilation

anion gap metabolic acidosis

MUDPILES methanol uremia drugs/diabetic ketoacidosis propylene glycol, paraldehyde isoniazid, iron lactic acidosis, linezolid ethylene glycol/ethanol salicylates

non-anion gap metabolic acidosis

FUSEDCARS fistula uretero-gastric conduit saline administration endocrine diarrhea carbonic anhydrase inhibitor ammonium chloride renal tubular acidosis spironolactone

metabolic acidosis treatment

correct underlying cause IV sodium bicarbonate THAM (tromethamine 0.3%)

IV sodium bicarbonate can be considered when

ph < 7.2 or pH < 7.3 AND ongoing acidosis/toxin elimination

IV sodium bicarbonate risks

can worsen intracellular pH risk of overcorrection

IV sodium bicarbonate has a potential to use if patient has been in

cardiac arrest over 15 mins

ADRs of IV sodium bicarbonate

shift of oxyhemoglobin saturation curve to the left sodium and water overload paradoxical tissue acidosis decreased myocardial contractility

goal of IV sodium bicarbonate

increase pH > 7.2 not to normalize

what to monitor when using IV sodium bicarbonate

hypo/hyperK while starting/stopping

THAM

proton acceptor (buffer) to prevent/treat acidosis osmotic diuretic less tissue acidosis than sodium bicarbonate

ADRs of THAM

respiratory depression severe tissue necrosis vascular spasm phlebitis pain hyperkalmeia hypoglycemia hypocalcemia impaired coagulation

contraindications with THAM

HF ESRD asthma

you must have ___________ access when using THAM

central IV

metabolic alkalosis is a result of

increased bicarbonate

compensatory mechanism of metabolic alkalosis

increase PCO2 by decreasing respiratory rate

metabolic acidosis is further classified as

chloride responsive chloride unresponsive

clinical presentation of metabolic alkalosis

cardiac arrhythmias respiratory depression/hypoxia tetany, hyperactive reflexia mental confusion

chloride responsive (normal urine chloride) causes

alkali administration contraction alkalosis decreased chloride intake non-urinary chloride loss post-hypercapnia villous adenomas

chloride unresponsive (elevated urine chloride) causes

glucocorticoids diuretics hypokalemia mineralocorticoids (cushings, hyperaldosteronism, batters syndrome)

chloride responsive metabolic alkalosis treatment

replace chloride with NaCl, KCl, acetazolamide

chloride unresponsive metabolic alkalosis treatment

potassium replacement (K sparing diuretics) decreased mineralocorticoid activity

stepwise approach to determining type of acid/base abnormality

1. evaluate the pH 2. evaluate the PCO2 3. evaluate the HCO3 4. compare the PCO2, HCO3, pH 5. calculate the anion gap, especially if metabolic acidosis present

if one moves in the same direction as pH, it is most likely

the primary disturbance

if one moves in the opposite direction as pH, it is most likely

the compensatory change

if both move in the same direction as pH, there is likely a

mixed disturbance occurring

when the serum anion gap is over 12,

anion gap metabolic acidosis

when the serum anion gap is equal to or less than 12

non-anion gap metabolic acidosis

if the anion gap is over 20,

there is primary metabolic acidosis present regardless of pH or serum bicarbonate concentration

Acid Base (exam 3) Flashcards

(68 cards)