Fluids, electrolytes, & acid-base 4

Question 1

The body attempts to regulate blood pH to

Answer 1

7.40

Question 2

Normal pH is

Answer 2

7.35-7.45

Question 3

Acidosis pH is

Answer 3

<7.35

Question 4

_______________ details how PaCO2 and HCO3 influence pH.

Answer 4

The Henderson-Hasselbalch equation

Question 5

Buff systems that help mitigate pH changes include

Answer 5

the blood (bicarbonate & hemoglobin)
lungs (changes in ventilation)
kidneys

Question 6

What is normal HCO3?

Answer 6

22-26 mEq/L

Question 7

What 5 questions should you ask yourself when evaluating pH?

Answer 7

1. Is the pH normal
2. Is the PaCO2 normal
3. Is the HCO3- normal
4. Has compensation occurred?
5. If there’s metabolic acidosis, is the anion gap normal or increased?

Question 8

Acidosis causes ___________________ P50, SNS stimulation, risk of dysrhythmias, myocardial depression, increased pulmonary vascular resistance, hyperkalemia, and increased ICP

Answer 8

Increased

Question 9

Alkalosis causes ______________ P50, decreased coronary blood flow, risk of dysrythmias, decreased cerebral blood flow, decreased pulmonary vascular resistance, hypokalemia, and decreased ionized calcium.

Answer 9

decreased

Question 10

H+ is __________ cells and K+ is _____________ cells

Answer 10

transported into cells and K+ is transported out of cells

Question 11

Acidosis is often accompanied by _________kalemia

Answer 11

hyperkalemia

Question 12

What is a normal anion gap?

Answer 12

8-12 mEq/L

Question 13

Metabolic acidosis can have a

Answer 13

normal anion gap & an increased anion gap

Question 14

Reasons for an increased anion gap in the setting of metabolic acidosis include

Answer 14

MUDPILES
methanol
uremia
diabetic ketoacidosis
paraldehyde
isoniazid
lactate
ethanol, ethylene glycol
salicylates

Question 15

Reasons for a normal anion gap in the setting of metabolic acidosis include

Answer 15

HARDUP
hyperaldosteronism
acetazolamide
renal tubular acidosis
diarrhea
uretosigmoid fistula
pancreatic fistula

Question 16

Full compensation causes pH

Answer 16

to return to normal

Question 17

Compensation for metabolic disorders is ________- due to changes in _______________

Answer 17

rapid; changes in minute ventilation

Question 18

Consider a mixed disorder if

Answer 18

the PaCO2 & bicarb both shift towards acidosis or alkalosis
the PaCO2 & bicarb are abnormal, but the expected degree of compensation did not occur

Question 19

Which acid-based disorder is MOST likely to occur in response to untreated pain in the PACU?
a. respiratory acidosis
b. respiratory alkalosis
c. metabolic acidosis
d. metabolic alkalosis

Answer 19

b. respiratory alkalosis

Question 20

Respiratory acidosis occurs when

Answer 20

alveolar ventilation fails to keep up with CO2 production

Question 21

Causes of hypercarbia include

Answer 21

increased CO2 production
decreased CO2 elimination
rebreathing

Question 22

Reasons for increased CO2 production include

Answer 22

sepsis
thyroid storm
MH

Question 23

Reasons for decreased CO2 elimination include

Answer 23

airway obstruction
COPD
opioid overdose

Question 24

Reasons for rebreathing include

Answer 24

incompetent unidirectional valve
exhausted soda lime

Question 25

Mechanical ventilation is indicated when the pH is less than

Answer 25

7.20

Question 26

Respiratory alkalosis occurs when

Answer 26

alveolar ventilation exceeds CO2 production

Question 27

Causes of respiratory alkalosis include

Answer 27

iatrogenic (mechanical ventilation) pain pulmonary embolism hypoxia anxiety pregnancy drugs (progesterone, salicylates)

Question 28

With acute respiratory acidosis, for every 10 mmHg increase in PaCO2, pH

Answer 28

decreases by 0.08

Question 29

With chronic respiratory acidosis, for every 10 mmHg increase in PaCO2, pH

Answer 29

decreases by 0.03

Question 30

During respiratory acidosis, the kidneys

Answer 30

excrete hydrogen & conserve bicarbonate to return pH to normal

Question 31

In the lungs, CO2 is a

Answer 31

direct-acting vasoconstrictor, where it can cause pulmonary hypertension and increase the right ventricular workload

Question 32

The most common cause of respiratory acidosis is

Answer 32

hypoventilation

Question 33

The MOST likely etiologies of metabolic alkalosis include: (select 2) a. large volume resuscitation with NaCl b. vomiting c. massive transfusion d. diabetic ketoacidosis

Answer 33

b. vomiting c. massive transfusion

Question 34

Metabolic acidosis is caused by an

Answer 34

accumulation of nonvolatile acids loss of bicarbonate large volume resuscitation with a sodium chloride solution

Question 35

_____________ helps to determine the cause of acidosis

Answer 35

the anion gap

Question 36

An increased anion gap occurs in the setting of

Answer 36

diabetic ketoacidosis, salicylates, and cyanide poisoning

Question 37

A normal anion gap occurs in the setting of

Answer 37

diarrhea, pancreatic fistula, and resuscitation with NaCl solutions

Question 38

_______________ used for anion gap acidosis is controversional.

Answer 38

Sodium bicarbonate

Question 39

Sodium bicarbonate is best used as a

Answer 39

temporary measure if the pH is <7.2 and the patient is hemodynamically unstable

Question 40

Metabolic alkalosis is caused by

Answer 40

increased bicarbonate (iatrogenic), loss of nonvolatile acids (continuous NG suction), and increased mineralocorticoid activity (Cushing's syndrome)

Question 41

How do you calculate the anion gap?

Answer 41

Na+ - Cl- + HCo3

Question 42

Accumulation of acid leads to

Answer 42

gap acidosis

Question 43

Loss of bicarbonate or ECF dilution leads to

Answer 43

non-gap acidosis

Question 44

An anion gap acidosis is defined as

Answer 44

pH <7.35 and anion gap >14

Question 45

PaCO2 decreases by _______ for every HCO3- decrease of 1 mEq/L

Answer 45

1-1.5 mmHg

Question 46

Administering sodium bicarbonate for non-anion gap acidosis is generally

Answer 46

useful because most of the etiologies produce bicarbonate loss

Question 47

PaCO2 increases by _______- for every HCO3- increase of 1 mEq/L

Answer 47

0.5-1 mmHg

Question 48

Treatment for metabolic alkalosis includes

Answer 48

treat the underlying cause -acetazolamide (increases renal excretion of bicarb) dialysis -spironolactone (mineralcorticoid antagonist)

Question 49

Name 5 etiologies that lead to metabolic alkalosis.

Answer 49

massive blood transfusion vomiting diuretics Cushing's syndrome hyperaldosteronism