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Respiratory Acidosis And Alkalosis Flashcards

(70 cards)

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1
Q

Normal pH range of arterial blood

A

7.35-7.45

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2
Q

Normal pH of venous blood

A

7.31-7.41

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3
Q

Why is arterial blood gas being used less often

A

Invasive
Painful

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4
Q

Acidaemia

A

State where arterial blood pH <7.35

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5
Q

Acidosis

A

Process leading to acidaemia

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6
Q

Alkalaemia

A

State where arterial blood pH >7.45

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7
Q

Alkalosis

A

Process leading to alkalaemia

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8
Q

Bicarbonate buffer system equation

A

CO2 + H2O <—> H2CO3 <—> H+ + HCO3

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9
Q

Does the human body normally have a higher concentration of HCO3- or CO2

A

HCO3-

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10
Q

What organ controls CO2 levels

A

Lungs

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11
Q

What is the weak acid and conjugate base in the bicarbonate buffer system

A

Weak acid - CO2
Conjugate base - HCO3-

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12
Q

Henderson hasselbach equation

A

pH = pKa + log ([conjugate base]/[weak acid])

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13
Q

Why is CO2 classed a s a weak acid

A

CO2 levels determine formation of carbonic acid

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14
Q

What ratio is blood pH dependent on

A

[HCO3-] : pCO2

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15
Q

Do the lungs or kidneys compensate more quickly for abnormal blood pH

A

Lungs

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16
Q

Which organ controls HCO3- concentration

A

Kidneys

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17
Q

4 forms of acid base disturbance

A

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

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18
Q

What causes respiratory acidosis

A

Inadequate pulmonary excretion of CO2

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19
Q

What causes respiratory alkalosis

A

Excess pulmonary excretion of CO2

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20
Q

What causes metabolic acidosis

A

Excess loss of HCO3 via kidney/GI tract or excess H+ production that consumes HCO3

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21
Q

What causes metabolic alkalosis

A

Excess loss of protons via kidney or GI tract

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22
Q

Which form of acid base disturbance has 2 possible mechanisms

A

Metabolic acidosis

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23
Q

What can cause inadequate CO2 excretion

A

Hypoventilation
Ventilation perfusion mismatch

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24
Q

What conditions can cause respiratory acidosis

A

Brain injury to CNS resp centres
Diseases of gas exchange
Diseases of chest
Diseases of nerves + muscles driving ventilation
Severe obesity
Drugs that suppress breathing

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25
How can scoliosis lead to respiratory acidosis
Impaired ventilation
26
How does pCO2 increase with no compensation affect plasma pH
Decrease - more acidic
27
Over what time frame is HCO3- raised/lowered to compensate for respiratory acidosis or alkalosis
Few hrs to starts 3-5 days for full effect
28
Which way is the bicarbonate buffer system pushed if pCO2 increases w no compensation
To Right
29
Is CO2 a lipid soluble or water soluble gas
Lipid soluble
30
Does CSF or plasma change pH more quickly
CSF
31
Why does CSF change pH more quickly than plasma in response to elevated pCO2
CSF has little protein so less buffered than plasma
32
Can CO2 cross the blood brain barrier
Yes
33
Respiratory acidosis symptoms
Headache Lethargy Anxiety Sleepiness Fatigue Memory loss Restlessness Muscle weakness
34
Respiratory acidosis signs
Drowsiness Gait disturbance Decr deep tendon reflexes Disorientation Tremor Myoclonic jerks Papilloedema Tachycardia Cardiac arrhythmia Decr BP skin flushing
35
Why does skin flush during respiratory acidosis
CO2 causes vasodilation
36
How does respiratory acidosis decr brain blood flow
Incr CO2 causes cerebral artery vasodilation -> incr intracranial pressure -> decr blood flow
37
Does acute or chronic respiratory acidosis have more severe symptoms
Acute
38
How does the brain compensate for respiratory acidosis
Reabsorbs more HCO3
39
Why are signs and symptoms less severe in chronic respiratory acidosis than acute
Brain and kidneys have time to compensate
40
How is respiratory acidosis diagnoses
Arterial blood gas Signs and symptoms
41
Acute respiratory acidosis ABG findings
Low blood pH High blood pCO2 Normal plasma HCO3- levels
42
Chronic respiratory acidosis ABG findings
Low normal blood pH High blood pCO2 High blood HCO3-
43
How is respiratory acidosis treated
Treat underlying cause - bronchodilator drugs, noninvasive positive pressure ventilation, opioid OD reversal, oxygen
44
Which respiratory acidosis patients can be harmed by giving oxygen
Patients with chronic hypercapnia from chronic CO2 retention and chronic respiratory acidosis
45
Why should patients with chronic hypercapnia be given oxygen very carefully
Can worsen CO2 retention from ventilation perfusion mismatch
46
Where is carbonic anhydrase present
All cells - not plasma
47
What does carbonic anhydrase catalyse
Bidirectional conversion of CO2 + H2O <—> HCO3- + H+
48
How can kidneys compensate for respiratory acidosis
Incr HCO3- reabsorption in kidney proximal tubule Incr H+ excretion Incr ammonium excretion Incr phosphate excretion
49
Where does phosphate excreted as part of metabolic compensation for respiratory acidosis come from
Breakdown of Calcium phosphate in bones
50
What is the mechanism of primary respiratory alkalosis
Lungs exhale higher than normal amount of CO2 causing hypocapnia
51
What type of acid base imbalance is caused by hyperventilation
Respiratory alkalosis
52
Acute respiratory alkalosis symptoms
Hyperventilation Dizziness Light headedness Confusion Agitation Blurred vision Cramps Tingling/numbing around mouth - Hands
53
Acute respiratory alkalosis signs
Muscle twitching Hyperactive reflexes Spasms Weakness Seizures Syncope Irregular heartbeat Tetany
54
How can respiratory alkalosis cause tetany
Decr in free calcium
55
What position is the typical alkalaemia hand spasm
Flexed wrist Extended DIPs and PIPs
56
Does calcium protein binding increase or decrease with pH increase
Increase
57
Why does pH affect free calcium levels
Calcium ions compete with H+ to bind to albumin, more H+ -> less Ca binding -> more free Ca
58
Metabolic effects of respiratory alkalosis
Constriction of cerebral blood vessels Impaired O2 delivery to tissues Incr neuromuscular activity -> arrhythmias and tetany
59
Tetany
Involuntary and sustained muscle contraction
60
Why does chronic respiratory alkalosis lead to hypokalaemia
Incr potassium excretion to replace H+ excretion
61
Causes of respiratory alkalosis
CNS lesions Salicylate overdose Pulmonary embolism Pregnancy Anxiety/stress Pain Liver cirrhosis Sepsis Hypoxaemia Fever
62
How is respiratory alkalosis diagnosed
Symptoms ABG
63
How is respiratory alkalosis treated
Treat underlying cause
64
Why does breathing into paper bag help hyperventilation syndrome
Rebreathed air has high CO2 restoring CO2 levels
65
How does the kidney compensate for chronic respiratory alkalosis
Incr bicarbonate excretion by decr carbonic anhydrase levels
66
Which type of respiratory failure has hypercapnia as well as hypoxaemia
Type 2
67
Which form of respiratory failure is more common
Type 1
68
How can alveolar impairment cause hypoxaemia without causing hypercapnia
CO2 diffuses out more easily than O2 diffuses in
69
What conditions can cause type 1 respiratory failure
Pulmonary oedema Pneumonia Pulmonary embolism
70
What conditions can cause type 2 respiratory failure
Severe COPD chest wall deformity Respiratory muscle weakness Central nervous system depression/injury Asthma attacks

CR2 (33 decks)

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