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Flashcards in Acid-Base (Martucci) Deck (73)
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1

Primary disturbance in metabolic acidosis?

Decrease bicarb

2

Compensatory response metabolic acidosis?

Decrease PCO2

3

Primary disturbance metabolic alkalosis?

Increase bicarb

4

Compensatory response metabolic alkalosis?

Increase PCO2

5

Primary disturbance respiratory acidosis?

Increase PCO2

6

Compensatory response respiratory acidosis?

Increase bicarb

7

Primary disturbance respiratory alkalosis?

Decrease PCO2

8

Compensatory response respiratory alkalosis?

Decrease bicarb

9

Respiratory acidosis (resulting from respiratory insufficiency can be caused by what 3 categories of issues?

1. Suppression of central respiratory center (opiates, anesthetics, excessive O2 in COPD)
2. ALI (ARDS, LVF, Pneumonia, Pneumothorax)
3. Respiratory muscle failure (Guillain-Barre, Myasthenia Gravis, Severe hypokalemia, hypophosphatemia)

10

What is respiratory acidosis characterized by?

pH under 7.4 and a PCO2 over 40 (compensation by rise in CO2)

11

How is acute compensation of respiratory acidosis done?

Intracellular buffering

12

How is chronic compensation of respiratory acidosis done?

Renal retention of bicarb

13

How do you treat respiratory acidosis?

Treat underlying disorder:
1. COPD exacerbation (steroids, ventilation, O2, antibiotics)
2. CHF (loop diuretics, ventilation)
3. Narcotic overdose (Naloxone)

14

Respiratory alkalosis due to hyperventilation can be caused by?

1. Stimulation of respiratory center (anxiety, pain, fever, ASA, liver disease, sepsis, CNS disease,progesterone)
2. Cardiopulmonary disease
3. Hypoxemia
4. Conscious control of respiration (ventilator, psyc)

15

What is respiratory alkalosis characterized by?

pH greater than 7.4 and a PCO2 under 40 (with compensation via decrease in CO2

16

How is acute compensation of respiratory alkalaosis done?

Intracellular buffering

17

How is chronic compensation of respiratory alkalosis done?

Renal secretion of bicarb

18

What is treatment for respiratory alkalosis?

Treat underlying disorder, intubate, sedate, paralyze, paper bag

19

Can you have respiratory acidosis and alkalosis?

NOPE... you either breathe too fast or too flow

20

Metabolic alkalosis (cased by an increase in plasma bicarb is caused by what 2 phases?

Generation or maintenance

21

What are causes of generation phase of metabolic alkalosis?

1. Loss of H (NG suction, vomiting, vilious adenoma, excess mineralocorticoid, diuretics)
2. Gain of bicarb (oral or IV supplements, TPN, lactated ringers, blood transfusion)
3. Volume contraction (diuretics...increase distal NaCL delivery...negative tubular lumen and enhanced H secretion)

22

What are causes of maintenance phase of metabolic alkalosis?

Kidneys inability to excrete the excess bicarbonate
1. Hypovolemia
2. Hypokalemia
3. Excessive mineralocorticoid
4. Hypochloremia

23

How do you determine if 0.9% NaCl will correct metabolic alkalosis?

Check the urine chloride

24

If the urine chloride is under 20mEq/L will 0.9% NaCl correct it?

YES

25

If the urine chloride is over 20mEq/L will 0.9% NaCl correct it?

NO

26

What can cause chloride sensitive metabolic alkalosis?

Vomiting, NG suction, diuretics, LR, TPN, blood

27

How do you treat chloride sensitive metabolic alkalosis?

With NS

28

What can cause hypertensive chloride resistant metabolic alkalosis?

1. Primary hypoaldosteronism
2. Cushing's syndrome
3. Pseudohyperaldosteronism
4. Hyperreninism
5. Congential adrenal hyperplasia

29

What can cause normotensive chloride resistant metabolic alkalosis?

1. Severe hypokalemia
2. Bartter's (defect in thick ascending limb of loop of henle characterized by low K levels, increase blood pH, and normal to low BP)
3. Milk-Alkali (hypercalcemia caused by repeated ingestion of Ca and absorbable alkali... calcium carbonate, milk, and sodium bicarb)

30

What is the equation for expected PCO2 compensation in metabolic alkalosis?

PCO2 = 0.7 * Bicarb + 20

+/- 1.5