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GU > Acid-Bases Disorders & ABGs > Flashcards

Acid-Bases Disorders & ABGs Flashcards

1
Q

Define acidemia vs acidosis

A
  • acidemia: increase in blood H+ (pH <7.35)
  • acidosis: pathophysiologic process that acidifies body fluids
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2
Q

Define alkalemia vs alkalosis

A
  • alkalemia: decrease in blood H+ (pH >7.45)
  • alkalosis: pathophysiologic process that alkalinizes body fluids
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3
Q

Define acid-base disorders

A

changes on CO2 partial pressure (pCO2) or serum bicarbonate (HCO3-) that produces abnormal arterial pH values

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4
Q

Which is the acid and which is the base: CO2, HCO3

A

CO2 = acid

HCO3 = base

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5
Q

Which organ compensates for metabolic acidosis/alkalosis

A

Lungs - manages CO2 levels via hypo/hyperventilation

  • takes minutes to compensate
  • CAN’T have respiratory acidosis & alkalosis at the same time
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6
Q

Which organ compensates for respiratory acidosis/alkalosis

A

Kidneys - manages HCO3 levels via excretion/absorption

  • takes days to compensate
  • CAN have metabolic acidosis/alkalosis at the same time
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7
Q

What is an anion gap

A

measure of the difference between negatively charged and positively charged electrolytes in the blood (cations = positive, anions = negative)

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8
Q

why does chloride loss result in metabolic alkalosis?

A

less chloride ions are available to exchange with bicarb so the ability to excrete excess bicarb from kidney is impaired

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9
Q

Describe the pathophys of respiratory acidosis

A
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10
Q

Describe the etiology of respiratory acidosis

A

low pH and high pCO2

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11
Q

What is the presentation of respiratory acidosis

A

somnolence, confusion, AMS, asterixis, seizures or coma if severe

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12
Q

What test should be done before getting an ABG from the radial artery

A

Allen’s test to check for good flow of the ulnar artery to continue hand perfusion

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13
Q

Describe the pathophys of respiratory alkalosis

A
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14
Q

Describe the etiology of respiratory alkalosis

A

high pH and low pCO2

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15
Q

Describe the presentation of respiratory alkalosis

A
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16
Q

Why is respiratory alkalosis usually self limited

A

because muscle fatigue/weakness will suppress ventilation

17
Q

Describe the etiology of metabolic acidosis

A
18
Q

Describe the presentation of metabolic acidosis

A
19
Q

Describe the diagnosis of metabolic acidosis

A
20
Q

Describe the treatment of metabolic acidosis

A

admit! treat underlying cause

21
Q

Describe the pathophys of HAGMA and NAGMA

A
22
Q

Describe the etiology of metabolic alkalosis

A
23
Q

Describe the treatment of metabolic alkalosis

A
24
Q

What are the components of an ABG measurement

A
  • pH 7.35-7.45
  • PaO2 (generally >80 mmHg)
  • PaCO2 (35-45 mmHg)
  • HCO3 (21-27 mEq/L)

Sometimes:
- carboxyhemoglobin (<3%)
- methemoglobin (<1%)

25
Q

Describe the use of VBG over ABG

A
  • less invasive/painful
  • convenient
  • not useful for oxygenation
  • different values
26
Q

Describe the approach to ABG analysis

A
  1. determine acidemia vs alkalemia
  2. determine primary disorder (respiratory - acute vs chronic, metabolic - HAGMA v NAGMA)
  3. is there appropriate compensation
  4. what is the clinical diagnosis
27
Q

How do you determine if there is metabolic vs respiratory acidosis on ABG?

A

relationship of pH and pCO2 with HCO3*

  • ROME: respiratory opposite, metabolic equal
28
Q

How do you determine appropriate compensation on ABG analysis?

A

pCO2 and HCO3 should move in the SAME direction

compensation always moves in the SAME direction as the primary disorder

(if the compensation is higher/lower than expected pCO2 or HCO3 values using given equations - think mixed disorder like resp acidosis with metabolic alkalosis)

29
Q

What element of an ABG are you looking at to determine expected compensation for respiratory vs metabolic processes

A
  • respiratory: expected HCO3
  • metabolic: expected pCO2
30
Q

Define partial compensation on ABG

A

compensatory mechanism tried but failed to bring the pH back to normal

(pH still out of range and pCO2 & HCO3 both high or both low)

31
Q

Define uncompensated on ABG

A

no change in compensatory mechanism

(pH still out of range and either pCO2 or HCO3 out of range while other is normal)

32
Q

Define full compensation on ABG

A

compensatory mechanism brought pH back to normal

(pH within normal limits while pCO2 and HCO3 both high or both low)

33
Q

How do you determine an acute vs chronic process on ABG analysis

A

look at clinical picture

GU (13 decks)

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