Respiratory Acidosis and Alkalosis

Question 1

pH Equation

Answer 1

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

Question 2

Respiratory Acidosis and Alkalosis

Answer 2

Respiratory Acidosis and Alkalosis

• pH = 6.1 + log HCO3/pCO2

Question 3

Metabolic compensation to respiratory alkalosis and acidosis:

Answer 3

Metabolic compensation to respiratory alkalosis and acidosis:

the kidneys slowly alter the HCO3 in an attempt to return the pH to normal.

Question 4

Rules for acid base disturbances

Answer 4

Rules for acid base disturbances

Check pH for alkalosis or acidosis

2. Is it metabolic or respiratory?
3. Calculate anion gap
4. Is compensation appropriate? (Calculations listed on the next slide) If not it is a mixed disorder.

5. What clinical condition is present that will explain the blood gas changes?

6. A sole primary disorder with normal compensation will never correct back to normal pH of 7.40.

Question 5

Compensation Equations

Metabolic Acidosis

Answer 5

Compensation Equations

Metabolic Acidosis → (delta)pCO₂ = 1.2 X DHCO₃

Question 6

Compensation Equations

Metabolic Alkalosis

Answer 6

Compensation Equations

Metabolic Alkalosis → (delta)pCO₂ = 0.7 X DHCO₃

Question 7

Compensation Equations

Acute Respiratory Acidosis

Answer 7

Compensation Equations

Acute Respiratory Acidosis →

(delta)HCO₃ = 0.1 X (delta)pCO₂

Question 8

Compensation Equations

Chronic Respiratory Acidosis

Answer 8

Compensation Equations

Chronic Respiratory Acidosis →

(delta)HCO₃ = 0.4 X (delta)pCO₂

Question 9

Compensation Equations

Acute Respiratory Alkalosis

Answer 9

Compensation Equations

Acute Respiratory Alkalosis →

(delta)HCO₃ = 0.2 X (delta)pCO₂

Question 10

Compensation Equations

Chronic Respiratory Alkalosis

Answer 10

Compensation Equations

Chronic Respiratory Alkalosis →

(delta)HCO3 = 0.5 X (delta)pCO2

Question 11

A 48 y/o male with cirrhosis of the liver is brought to the ER after ingesting 30 ASA tablets in a suicide attempt. Temperature is 38.8 C (102 F) with pulse of 100. Respirations are 28 breaths/min. He has ascites, peripheral edema, and carpopedal spasms. Sodium is 120 meq/L, BUN is 60 mg/dL with creatinine is 2 mg/dL. Glucose is 60 mg/dL. A blood gas is drawn and shows:

pH = 7.60 – acidosis or alkalosis?

HCO3 = 21 meq/L

pCO2 = 20 mmHg

What is this acid base problem called?

(on top of the fact that this dude puts the DUH in “Big Huge Attention Grabbing Dumb Butt”)

Answer 11

pH = 7.60 – acidosis or alkalosis?

ALKALOSIS

What is this acid base problem called?

Uncompensated Acute Respiratory Alkalosis

Question 12

Uncompensated Acute Respiratory Alkalosis

or as represented by a chart

Answer 12

Question 13

A 48 y/o male with cirrhosis of the liver is brought to the ER after ingesting 30 ASA tablets in a suicide attempt. Temperature is 38.8 C (102 F) with pulse of 100. Respirations are 28 breaths/min. He has ascites, peripheral edema, and carpopedal spasms. Sodium is 120 meq/L, BUN is 60 mg/dL with creatinine is 2 mg/dL. Glucose is 60 mg/dL. A blood gas is drawn and shows:

pH = 7.60

HCO3 = 21 meq/L

pCO2 = 20 mmHg

If the respiratory alkalosis were to continue for 2-3 days?

Answer 13

If the respiratory alkalosis were to continue for 2-3 days, the kidneys will compensate by Excreting HCO3:

Question 14

If the respiratory alkalosis were to continue for 2-3 days?

Useless Stupid @$$ chart format

Answer 14

Question 15

Causes of Respiratory Alkalosis

Answer 15

Causes of Respiratory Alkalosis

1. SIRS
2. Hypoxia
3. Cirrhosis
4. Pregnancy
5. ASA poisoning
6. Anxiety-Hyperventilation
7. Cerebral hemorrhage or thrombosis

Question 16

A 34 y/o male is involved in a MVA and suffers fractured ribs. He is seen in the ER and blood gases show:

• pH = 7.22
• pCO₂ = 70 mmHg
• HCO₃ = 28

What is this acid base problem called?

(no its not called sux to be this guy)

Answer 16

Uncompensated Respiratory Acidosis

Question 18

A 34 y/o male is involved in a MVA and suffers fractured ribs. He is seen in the ER and blood gases show:

pH = 7.22

pCO2 = 70 mmHg

HCO3 = 28

Uncompensated Respiratory Acidosis

(Retard Chart Format)

Answer 18

Uncompensated Respiratory Acidosis

(Retard Chart Format)

Question 19

Compensated Respiratory Acidosis

Answer 19

Compensated Respiratory Acidosis

Question 20

Compensated Respiratory Acidosis

(again with the frig’n chart)

Answer 20

Compensated Respiratory Acidosis

(again with the frig’n chart)

Question 21

A “blue bloater” (aka sexy beast) from the local nursing home comes into your office for his 3 month check up. Your nurse applies O₂ due to his cyanosis and he becomes somolent, confused and manifest asterixis. Physical exam shows papilledema.

Blood gas is drawn showing:

• pH = 7.24
• pCO₂ = 90 mmHg
• pO₂ = 40 mmHg

Electrolytes show as:

Na - 140 meq/L

K - 4.02 meq/L

Cl - 93 meq/L

HCO₃ - 39meq/L

What has happened?

(aside from the fact that all the women in your office lost their minds because homie took his shirt off and they couldn’t handle the industrial strength sexy)

Answer 21

Primary Respiratory Acidosis with compensation and subsequent decompensation