Flashcards in Acid-Base (Martucci) Deck (73)
Primary disturbance in metabolic acidosis?
Compensatory response metabolic acidosis?
Primary disturbance metabolic alkalosis?
Compensatory response metabolic alkalosis?
Primary disturbance respiratory acidosis?
Compensatory response respiratory acidosis?
Primary disturbance respiratory alkalosis?
Compensatory response respiratory alkalosis?
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)
What is respiratory acidosis characterized by?
pH under 7.4 and a PCO2 over 40 (compensation by rise in CO2)
How is acute compensation of respiratory acidosis done?
How is chronic compensation of respiratory acidosis done?
Renal retention of bicarb
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)
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
4. Conscious control of respiration (ventilator, psyc)
What is respiratory alkalosis characterized by?
pH greater than 7.4 and a PCO2 under 40 (with compensation via decrease in CO2
How is acute compensation of respiratory alkalaosis done?
How is chronic compensation of respiratory alkalosis done?
Renal secretion of bicarb
What is treatment for respiratory alkalosis?
Treat underlying disorder, intubate, sedate, paralyze, paper bag
Can you have respiratory acidosis and alkalosis?
NOPE... you either breathe too fast or too flow
Metabolic alkalosis (cased by an increase in plasma bicarb is caused by what 2 phases?
Generation or maintenance
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)
What are causes of maintenance phase of metabolic alkalosis?
Kidneys inability to excrete the excess bicarbonate
3. Excessive mineralocorticoid
How do you determine if 0.9% NaCl will correct metabolic alkalosis?
Check the urine chloride
If the urine chloride is under 20mEq/L will 0.9% NaCl correct it?
If the urine chloride is over 20mEq/L will 0.9% NaCl correct it?
What can cause chloride sensitive metabolic alkalosis?
Vomiting, NG suction, diuretics, LR, TPN, blood
How do you treat chloride sensitive metabolic alkalosis?
What can cause hypertensive chloride resistant metabolic alkalosis?
1. Primary hypoaldosteronism
2. Cushing's syndrome
5. Congential adrenal hyperplasia
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)