Acidosis

Question 1

what organs are affected by acid-base disorders?

Answer 1

heart, bones, skeletal muscle, kidneys

Question 2

What is the response of the bones when acid level is high in the body?

Answer 2

They break down releasing alkali to neutralize the acid. Calcium is released at the same time (kidney stones, osteoporosis)

Question 3

What happens in the heart in the presence of excess acid?

Answer 3

Increased risk of arrhythmia and impaired contractility

Question 4

What happens in the skeletal muscles as a result of excess acid?

Answer 4

Protein catabolism

Question 5

Calcium competes with __________ to bind with Albumin

Answer 5

Protons (H+)

Question 6

If you treat your acidotic patient with bicarb they will have a decrease in H+, what would you expect to happen to the patient’s calcium?

Answer 6

It would bind to albumen and there would be less free calcium

Question 7

If you have a decrease in H+, what would you expect to happen to Hemoglobin’s affinity for O2?

Answer 7

It would increase hgb’s affinity for oxygen (tissue would not want to release O2)

Question 8

if you have a decrease in H+, what would you expect to happen to respiration?

Answer 8

Low H+ inhibits respiration (slow respiration increases pCO2)

Question 9

what’s the equation to determine pH from H+ count?

Answer 9

pH=-log[H+]

Question 10

What is normal pH?

Answer 10

7.35-7.45

Question 11

What are the 2 factors that alter pH?

Answer 11

CO2 and HCO3-

Question 12

Where is bicarb created?

Answer 12

kidneys

Question 13

So the professor seemed to want us to know the Henderson-Hasselbach equation….but I think we just need to understand the idea that pH relies on bicarb and co2…..Just in case, what’s the HENDERSON-HASSELBACH EQUATION?

Answer 13

pH=6.1+log[(HCO3-)/0.03 * pCO2]

Question 14

How long does it take your body to produce a respiratory compensation to an acid-base situation?

Answer 14

seconds

Question 15

How long does it take your body to produce a metabolic compensation to an acid-base situation?

Answer 15

3-5 days

Question 16

If your patient shows signs of a metabolic compensation to a respiratory alkalosis, you can assume the patient’s respiratory alkalosis is _____________, and has been going on for __________days

Answer 16

chronic, >3-5 days

Question 17

What lab test would you order to measure pH?

Answer 17

1) Arterial blood gas (direct measure of pH and pCO2) AND
2) Plasma electrolytes (direct measure of HCO3-)

you can calculate HCO3- from the blood gases, and then test #2 confirms your calculation to let you know the test is valid.

Question 18

You’ve discovered an abnormal pH, what is the best thing you should do?

Answer 18

Identify and treat underlying cause (treating pH does not solve your problems)

Question 19

What are the 3 things that could cause metabolic acidosis?

Answer 19

1) too much acid (ASA and other meds)
2) not enough base/bicarb–not making enough in kidneys
3) not enough base/bicarb–losing too much in diarrhea

Question 20

THROWBACK: how do you calculate the target anion gap for your patient?

Answer 20

Normal gap is Age/10 + 10

Question 21

How do you calculate the actual anion gap for your patient?

Answer 21

All cations - anions

Question 22

If you have metabolic acidosis and no anion gap, what are the 2 potential causes?

Answer 22

1) renal tubular failure (can’t make enough bicarb)

2) diarrhea

Question 23

what test should we order if we want to know how much acid is being excreted?

Answer 23

chloride somehow translates to ammonia??

Question 24

The new “MUDPILES”–>

Answer 24

LAME SUDS. Only addition is “alcoholic ketoacidosis” REVIEW: lactic acidosis, alcoholic ketoacidosis, methanol, ethylene glycol, salicylates, uremia, DKA, sepsis

Question 25

Respiratory acidosis, as we know, is caused by excess CO2 which would occur if we weren’t breathing enough. What are the main causes of this respiratory failure? (ACUTE failure)

Answer 25

asthma, mucous plugs, pulmonary edema, narcotics

Question 26

What are the CHRONIC causes of respiratory failure?

Answer 26

cigarettes, COPD, chronic musculoskeletal deformities, chronic neuromuscular weakness