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2020 Foundations II > Acid-Base Imbalance > Flashcards

Acid-Base Imbalance Flashcards

1
Q

partially compensated

A

process has begun, but pH is abnormal

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2
Q

compensated

A

pH is normal, but CO2 and HCO3- are still abnormal

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3
Q

expected pH

A

7.35-7.45

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4
Q

expected PaCO2

A

35-45 mm Hg

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5
Q

expected HCO3

A

22-26 mm Hg

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6
Q

ROME for interpreting ABGs quickly

A
  • Respiratory
  • *O**pposite
    • pH ↑ PaCO2 ↓ alkalosis
    • pH ↓ PaCO2 ↑ acidosis
  • Metabolic
  • *E**qual
    • pH ↑ PaHCO3 ↑ alkalosis
    • pH ↓ PaHCO3 ↓ acidosis
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7
Q

alkalosis

A

↑ pH

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8
Q

acidosis

A

↓ pH

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9
Q

respiratory alkalosis

A

↓ pH

↑ PaCO2

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10
Q

respiratory acidosis

A

↓ pH

↑ PaCO2

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11
Q

metabolic alkalosis

A

↑ HCO3

↑ pH

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12
Q

metabolic acidosis

A

↓ HCO3

↓ pH

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13
Q

organs responsible for acid-base balance

A
  • kidneys: metabolic
  • lungs: respiratory
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14
Q

respiratory acid

A

CO2

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15
Q

metabolic alkaline component

A

HCO3

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16
Q

steps to interpret ABG

A
  • look at pH: high or low?
    • high = alkalosis
    • low = acidosis
    • normal + abornomal gas = fully compensated
  • look at PaCO2: opposite of pH?
    • yes = respiratory
  • look at HCO3: same direction as pH?
    • yes = metabolic
  • If neither both fit the pattern, it’s mixed
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17
Q

full compensation

A
  • pH is normal, but PaCO2 and PaHCO3 are abnormal
  • pH is slightly acidic or alkalotic
  • 7.4 = midpoint
  • 7.35-7.39 = slightly acidic = acidosis
  • 7.41-7.45 = slightly alkalotic = alkalosis
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18
Q

partial compensation

A
  • acidosis or alkalosis?
  • respiratory or metabolic (ROME)?
  • the other component won’t fit ROME pattern, and that’s the one that’s compensating
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19
Q

mixed acid-base imbalance

A

just metabolic or alkalotic

20
Q

mild hypoxemia

A

PaO2 = 60-79 mm Hg

21
Q

moderate hypoxemia

A

PaO2 = 40-59 mm Hg

22
Q

severe hypoxemia

A

PaO2 < 40 mm Hg

23
Q

expected PaO2

A

80-100 mm Hg

24
Q

pH 7.30

PaCO2 53

PaHCO3 24

A

respiratory acidosis

25
Q

pH 7.48

PaCO2 29

PaHCO3 23

A

respiratory alkalosis

26
Q

pH 7.32

PaCO2 44

PaHCO3 19

A

metabolic acidosis

27
Q

pH 7.52

PaCO2 36

PaHCO3 32

A

metabolic alkalosis

28
Q

pH 7.36

PaCO2 55

PaHCO3 31

A

fully compensated repiratory acidosis

29
Q

pH 7.43

PaCO2 50

PaHCO3 35

A

fully compensated metabolic alkalosis

30
Q

pH 7.47

PaCO2 30

HCO3 20

A

partially compensated repiratory alkalosis

31
Q

pH 7.47

PaCO2 30

PaHCO3 28

A

mixed alkalosis

32
Q

three types of compensatory mechanisms in acid-base disturbance and when they respond

A
  • buffers: seconds
  • respiratory: seconds to minutes
  • renal/kidney/metabolic: 24-48 hr
33
Q

respiratory acidosis

A
  • caused by hypoventilation of any etiology
    • COPD
    • oversedation
    • head trauma
    • anesthesia
    • neuromuscular dz like myasthenia gravis or Guillian-Barre
    • inappropriate mechanical ventilation
    • sleep apnea
  • s/sx
    • rapid, shallow respirations
    • ↓ BP
    • skin/mucosa pale to cyanotic
    • hyperkalemia
    • dysrhythmias (↑ K+)
    • drowsiness
    • dizziness
    • disorientation
    • muscle weakness
    • hyporeflexia
34
Q

respiratory acidosis Tx

A
  • assess airway for patency
  • patent
    • position in semi- to high Fowler’s
    • encourage coughing and deep breathing, incentive spirometry
    • oxygen therapy if needed
  • not patent: mechanical ventilation
  • medications
    • bronchodilators
    • anti-inflammatories
    • narcan (opioid overdose)
35
Q

metabolic acidosis***

A
  • harder to correct than respiratory imbalance
  • caused by gain in nonbolatile acids (ketoacids, lactic acid, etc.)
    • DKA
    • renal failure
    • lactic acidosis
    • poisoning
      • salicylates
      • ethylene glycol
      • methyl alcohol
      • paraldehyde
  • caused by loss of HCO3
    • diarrhea
    • drainage of***
    • liver damage
    • dehydration
36
Q

metabolic acidosis

A
  • headache
  • lower BP
  • hyperkalemia
  • muscle twitching
  • warm, flushed skin
  • nausea
  • vomiting
  • lower muscle tone
  • lower reflexes
  • confusion
  • drowsiness
  • Kussmaul respirations
37
Q

metabolic acidosis causes

A
  • ↑ H+ production
    • DKA
    • hypermetabolism
  • ↓ H+ elimination
    • renal failure
  • ↓ HCO3 production
    • dehydration
    • liver failure
  • ↑ HCO3 elimination
    • diarrhea
    • fistulas
38
Q

Tx: metabolic acidosis

A
  • hydration
  • meds to reverse cause
    • insulin
    • antidiarrheal
  • sodium bicarbonate to buffer in emergent period
    • rare because of rebound
39
Q

respiratory alkalosis

A
  • low PaCO2
  • caused by hyperventilation because of
    • hypoxemia
    • nervousness and anxiety
    • pulmonary embolism
    • pregnancy
    • inappropriate mechanical ventilation
    • compensation for metabolic acidosis
40
Q

s/sx of respiratory alkalosis

A
  • lightheadedness
  • hyperventilation (↑ rate and depth
  • tachycardia
  • ↓ or normal BP
  • hypokalemia
  • numbness and tingling in extremities or around lips
  • hyperreflexes and muscle cramping
  • sz
  • anxiety, irritability
41
Q

Tx for respiratory alkalosis

A
  • increase sedation
  • control pain/anxiety to lower resp rate
  • possible mechanical ventilation when lungs start to give out or regulate respirations
42
Q

metabolic alkalosis

A
  • elevated bicarb
  • loss of nonvolatile acids (keto and lactic)
  • loss of gastric acid (vomiting)
  • bicard admin during cardiac arrest
    • now only give if pH < 7.1 or 7.0
  • baking soda intake (usually for heartburn)
  • massive blood transfusion
  • ↑ intake of H+, K+, and Cl- because of
    • diuretics
    • Cushing’s
    • corticosteroids
    • aldosteronism
43
Q

s/sx of metabolic alkalosis

A
  • confusion
  • dysrhythmias
    • tachycardia r/t ↓ K+
  • hypoventilation (compensatory)
  • dizziness
  • increased irritability
  • nausea
  • vomiting
  • diarrhea
  • increased anxiety
  • sz
  • decreased serum Ca++
    • tremors
    • muscle cramps
    • tingling of fingers and toes
44
Q

Tx for metabolic alkalosis

A
  • stop Tx that may have caused it
    • NG tube suctioning
    • diuretics
    • bicarb admin
  • replace lost electrolytes
  • admin antiemetics
45
Q
A

2020 Foundations II (4 decks)

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