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Acid-Base (Moore) Flashcards

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1
Q

What way does the oxygen dissociation curve shift when alkalotic?

A

LEFT (oxygen has a higher affinity for hemoglobin)

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2
Q

Since the oxygen dissociation curve shifts left in an alkalotic patient, what does this mean for their saturation?

A

They might have good pO2 and O2 saturation, but they are pallid or cyanotic

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3
Q

What does a right shift of the oxygen dissociation curve imply?

A
  • Decreased affinity of O2 with hemoglobin
  • Decrease O2 carried from lungs
  • O2 given up more readily to the tissues
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4
Q

What are causes of right shift of oxygen dissociation curve?

A
  1. Acidosis (decreased pH)
  2. Elevated temperature
  3. Hypercarbia (elevated CO2)
  4. Increased DPG
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5
Q

What does a left shift of the oxygen dissociation curve imply?

A
  • Increased affinity of O2 with hemoglobin
  • Increased O2 carried from lungs
  • O2 given up less readily in the tissues
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6
Q

What are the causes of a left shift of the oxygen dissociation curve?

A
  1. Alkalosis (increased pH)
  2. Hypothermia
  3. Hypocarbia (decreased CO2)
  4. Decreased DPG
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7
Q

What are the 3 ways CO2 is transported and what are the % of each?

A
  1. 7% in plasma
  2. 23% carried in globin portion of hemoglobin
  3. 70% as bicarbonate in the plasma
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8
Q

What does carbonic anydrase do?

A

It can either combine CO2 and water to make carbonic acid or take carbonic acid and make CO2 and H20

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9
Q

What kind of acid is carbonic acid?

A

WEAK

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10
Q

How does the body prevent acidosis?

A

It takes a H ion from carbonic acid and buffers it with hemoglobin leaving bicarbonate ions

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11
Q

Where does bicarb move and in exchange for what?

A

Bicarb will move out of RBCs into plasma and Cl ion will move into the cell

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12
Q

In the lungs, what direction does the mass action equation move and what is the result of this ?

A

To the left to make CO2 to exhale

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13
Q

What is an acid and what is acidosis?

A
  • pH under 7
  • Gives up H ions
  • pH under 7.35
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14
Q

What is a base and what is alkalosis?

A
  • pH over 7
  • Accepts H ions
  • pH over 7.45
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15
Q

What is normal plasma pH?

A

Between 7.35 and 7.45

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16
Q

Cellular metabolism produces H ions from what?

A

Glucose, fatty acids, AA

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17
Q

How is acid/base balance maintained?

A

By controlling H ion concentration (body is very sensitive to small changes in H concentration)

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18
Q

What 3 systems are in place to maintain acid base balance?

A
  1. Buffering
  2. Respiratory
  3. Renal
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19
Q

What are buffers?

A

Chemicals that act quickly to temporary changes in H concentraion– Minimize changes in overall pH by accepting H ions when pH falls (acidosis) or by donating H ions when pH rises (alkalosis)

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20
Q

Is H removed from body?

A

NOPE…just removed from solution

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21
Q

What are the 3 buffering systems in the body?

A
  1. Carbonic acid-bicarbonate system
  2. Phosphate system
  3. Protein system (hemoglobin and plasma proteins)
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22
Q

What is the ratio of bicarb to carbonic acid needed to maintain a normal pH?

A

20:1

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23
Q

What are the functions of the buffering system?

A
  1. Provide important and immediate responses to potential changes in pH
  2. Prevent changes in pH until excess H ions can be excreted or bicarb levels can be resorted
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24
Q

What happens if the 20:1 ratio of bicarbonate to carbonic acid can’t be maintained?

A

A change in pH will occur

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25
Why is the respiratory system so important in the control of acid-base balance?
It can respond quickly (short term control of pH)
26
What happens when CO2 is dissolved in H20?
Bicarbonate is formed
27
By increasing the rate or depth of breathing and increasing the amount of CO2, the level of bicarb in the body...?
Will decrease...less CO2 means less bicarbonate
28
What effect does the renal system have on acid-base balance?
Long term control...regulates the secretion of bicarbonate ions and excreting acids via renal tubule cells
29
What are the 3 ways the renal tubule alters pH?
1. Secretes H ions into the filtrate, clearing the blood of excess acids and making the urine more acidic 2. Reabsorb bicarb ions 3. Produce new bicarb ions to augment the buffering of H ions in the blood
30
Respiratory acid base imbalances?
Lungs and CO2
31
Metabolic acid base imbalances?
Kidneys and Bicarb
32
What are mixed imalances
DANGEROUS
33
What other factor can be looked at along with bicarb?
Base excess (matches bicarb levels)
34
PCO2 increased?
Respiratory acidsosis (decreased CO2 elimination)
35
PCO2 decreased?
Respiratory alkalosis (increased CO2 elimination)
36
Bicarb/BE increased?
Metabolic alkalosis (acid lost or bicarb gained)
37
Bicarb/BE decrease?
Metabolic acidosis (acid added or bicarb used up or lost)
38
Normal pH?
7.35-7.45
39
Normal pO2?
80-100mmHg
40
Normal pCO2?
35-45mmHg
41
Normal bicarb?
22-25mmol/L
42
Normal BE?
-2 (+/-2)
43
Normal SaO2?
97%
44
Respiratory acidosis?
- pH low - pCO2 elevated - pO2 decreased
45
Probable causes of respiratory acidosis?
Respiratory failure, COPD
46
Treatment for respiratory acidosis?
Assisted ventilations....if already on a ventilator increase the minute volume or tidal volume to decrease pCO2
47
Metabolic acidosis?
- pH low - HCO3 low - BE low
48
Probable causes metabolic acidosis?
DKA, renal failure, sepsis
49
Treatment for metabolic acidosis?
Underlying problem
50
Respiratory alkalosis?
- pH elevated | - pCO2 low
51
Probable causes of respiratory alkalosis?
Ventilator, hysterical hyperventilation
52
Treatment for respiratory alkalosis?
Decrease minute volume or tidal volume so pCO2 can rise
53
Metabolic alklalosis?
- pH low - HCO3 elevated - BE elevated
54
Probable cause of metabolic alkalosis?
Hyperemesis
55
Why is blood gas analysis not always straight forward?
If pH is too high or too low, cellular function ceases
56
Can you have a widely abnormal gas with relatively normal pH?
Yes... the body has natural mechanisms for keeping pH in normal limits
57
What happens to compensate a respiratory acidosis (increased pCO2)?
The metabolic component (bicarb) will increase... the increasing alkalinity will bring the pH back to normal
58
What happens to compensate a metabolic acidosis (decreased bicarb)?
The respiratory component (CO2) will decrease by hyperventilation to blow off CO2 and compensate to bring pH back towards normal
59
What is full compensation?
Brings pH back to normal limit
60
What is partial compensation?
Some compensation, but not enough to alter the pH
61
What could be the problem in a respiratory acidosis with metabolic compentation and what is the treatment?
COPD... treat the underlying respiratory condition
62
Causes of respiratory acidosis?
Inadequate ventilation and retention of CO2 1. COPD 2. PE 3. Hypoventilation 4. Over sedation
63
How does the body compensate for respiratory acidosis?
Bicarb is reabsorbed by the kidneys to augment the buffering system of H ions in the blood
64
What are the causes of metabolic acidosis?
Excess acid production or loss of bicarb 1. DKA 2. Renal failure 3. Sepsis 4. Cardiac arrest
65
What is the compensation of metabolic acidosis?
Hyperventilation to increase rate and depth
66
What are the causes of respiratory alkalosis?
Any condition leading to hyperventilation causing excretion of too much CO2 1. Hysterical hyperventilation 2. Over mechanical ventilation
67
What is the compensation of respiratory alkalosis?
1. Rebreathing of CO2 | 2. Decrease ventilation tidal volume and rate
68
What are the causes of metabolic alkalosis?
Any condition leading to an increase in bicarb or loss of acid 1. Vomiting 2. Diuretic 3. Antacid overdose
69
What is the compensation of metabolic alkalosis?
Rate and depth of respiration are decreased in order to retain CO2
70
What is overcompensation?
When the pH becomes overcorrected by a compensation
71
What 2 situations can you see overcompensation in?
1. When a patient has metabolic acidosis and respiratory acidosis 2. When a patient has metabolic alkalosis and respiratory alkalosis
72
What do you treat in the overcompensation?
The primary problem... the overcomepnsation issue will then correct itself

Renal 2 (10 decks)

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