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Fa: Methods 2 > 3. Acid Base Management > Flashcards

3. Acid Base Management Flashcards

1
Q

venous CO2 normal value

A

24-30 mEq/L
(CO2 + HCO3-)

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2
Q

arterial CO2 normal value

A

22-26 mEq/L
(HCO3-)

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3
Q

PaCO2 normal

A

35-45 mmHg

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4
Q

PvCO2 normal

A

40-50 mmHg

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5
Q

PvCO2 is normally _______ compared to PaCO2

A

PvCO2 is 5 mmHg higher than PaCO2

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6
Q

if a pt is poorly perfused, what happens to the PvCO2:PaCO2 gradient

A

increases

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7
Q

PaO2 of atmosphere normal

A

160 mmHg (sea level)

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8
Q

PaO2 normal value

A

70-100 mmHg

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9
Q

what happens to PaO2 as you age?

A

it decreases

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10
Q

PvO2 normal value

A

30-40 mmHg

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11
Q

CaO2 normal value

A

16-20 mL/dL

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12
Q

CvO2 normal value

A

12-16 mL/dL

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13
Q

DO2

A

total delivery of O2 per minute

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14
Q

DO2 normal

A

1000 mL of O2 delivered per minute

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15
Q

normal Hb

A

15 g/dL

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16
Q

normal SaO2

A

93-98%

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17
Q

normal CO

A

5 L/min

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18
Q

mvO2 normal

A

60-80%
(up to 90%)

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19
Q

ScvO2 normal

A

70-75%

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20
Q

difference between PAO2 and PaO2

A

A-a gradient

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21
Q

A-a gradient: room air

A

5-15 mmHg

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22
Q

A-a gradient: elderly

A

15-25 mmHg

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23
Q

A-a gradient: 100% FiO2

A

10-110 mmHg

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24
Q

normal MV

A

7-8 L/min

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25
Q

Va =

A

2/3 of MV

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26
Q

Vd =

A

1/3 of MV

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27
Q

VCO2

A

200 mL/min

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28
Q

what happens to VCO2 under GA

A

decreased by up to 60%

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29
Q

VO2: normothermic adult

A

250 mL/min

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30
Q

VO2: infants

A

6-8 mL/kg/min

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31
Q

VO2: adults

A

3-4 mL/kg/min

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32
Q

pH

A

7.35-7.45

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33
Q

%MetHB on ABG

A

<2%

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34
Q

%COHb on ABG

A

<3%

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35
Q

HCO3-/PaCO2 ratio

A

20:1

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36
Q

PaO2/Fio2 ratio

A

480

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37
Q

Anion Gap

A

8-16 mEq/L

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38
Q

Base Excess

A

-2.0 - 2.0 mEq/L

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39
Q

serum lactate concentration

A

< 2 mmol/L

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40
Q

lactic acidosis

A

serum lactate > 5 mmol/L

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41
Q

Vt

A

volume of air expired in 1 breath
including dead space

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42
Q

MV

A

total volume of air breathed in 1 min
including dead space

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43
Q

MV =

A

MV = RR*Vt

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44
Q

Vd

A

volume of dead space in 1 breath

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45
Q

Vd: pulmonary dz

A

> 1/3 of Vt

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46
Q

Vd/Vt

A

amount of dead space ventilation that occurs in 1 min

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47
Q

Vd/Vt =

A

Vd/Vt = Vd*RR

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48
Q

alveolar volume

A

amount of air in 1 breath that reaches the alveoli and participates in gas exchange

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49
Q

alveolar volume =

A

alveolar vol = Vt - Vd

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50
Q

Va

A

amount of air in 1 min that reaches the alveoli and participates in gas exchange

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51
Q

Va =

A

Va = (Vt - Vd) *RR

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52
Q

blood gas: technically

A

gas under ordinary conditions
dissolved in our blood

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53
Q

blood gas: clinically

A

collection of values that may include actual blood gases but also include other values

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54
Q

ABG measures (6)

A
  1. pH
  2. PaCO2
  3. HCO3-
  4. PaO2
  5. SaO2
  6. Base excess
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55
Q

ABG additional values (6)

A
  1. Hb/Hct
  2. K+
  3. Glu
  4. Ca2+
  5. COHb
  6. MetHb
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56
Q

3 forms of CO2 in the body

A
  1. PaCO2
  2. HCO3- (plasma)
  3. HCO3- (Hb-bound)
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57
Q

PaCO2 accounts for ________ of all CO2

A

5-10%

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58
Q

HCO3- in plasma accounts for _______

A

60-65%

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59
Q

HCO3- bound to Hb accounts fo

A

30%

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60
Q

HCO3- total in body

A

90-95% of all CO2

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61
Q

lechatlier principle: drive RIGHT

A

incr CO2
or
decr HCO3-

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62
Q

lechatlier principle: drive LEFT

A

decr CO2
or
incr HCO3-

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63
Q

acids drive reaction

A

RIGHT

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64
Q

acids ____ H+

A

incr H+ ions

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65
Q

bases drive reaction

A

LEFT

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66
Q

bases ____ H+

A

decr H+ ions

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67
Q

respiratory acidosis cause

A

hypoventilation
incr PaCO2

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68
Q

respiratory acidosis diagnosis

A

low pH
high PaCO2

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69
Q

respiratory alkalosis cause

A

hyperventilation
decr PaCO2

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70
Q

respiratory alkalosis diagnosis

A

high pH
low PaCO2

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71
Q

metabolic acidosis cause

A

decr HCO3-

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72
Q

metabolic acidosis diagnosis

A

low pH
low HCO3-

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73
Q

metabolic alkalosis cause

A

incr HCO3-

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74
Q

metabolic alkalosis diagnosis

A

high pH
high HCO3-

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75
Q

pH is determine by

A

HCO3- to PaCO2 ratio

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76
Q

acidosis SE (6)

A
  1. decr contractility
  2. decr catecholamine response
  3. decr coag / incr bleeding
  4. incr PVR
  5. incr risk of Vfib
  6. incr plasma K+
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77
Q

alkalosis SE (6)

A
  1. shifts O2-Hb LEFT
  2. incr SVR
  3. cerebral vasoconstriction
  4. decr pVR
  5. decr plasma K+
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78
Q

pH ~

A

pH ~ HCO3- / PaCO2

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79
Q

base excess: technically

A

amount of acid or base needed to return the blood to pH 7.4 and PaCO2 to 40 mmHg

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80
Q

base excess: clinically

A

tells us if pt has too much or too little base in the blood

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81
Q

normal Base excess

A

-2 to 2 mmol/L

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82
Q

base excess > 2mmol/L

A

too much base
metabolic alkalosis

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83
Q

base excess < -2 mmol/L

A

not enough base
metabolic acidosis

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84
Q

what indicates metabolic acid/base status

A

base excess

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85
Q

what indicates respiratory acid/base status

A

PaCO2

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86
Q

PaCO2 should be _______ to EtCO2

A

PaCO2 should be 3-5 mmhg higher than EtCO2

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87
Q

if PaCo2 is significantly higher than EtCO2, then what might that suggest?

A
  1. lung disease
  2. hypotension
  3. low CO
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88
Q

PaCO2 =

A

PaCO2 = [(VCO2)*0.863]/Va

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89
Q

PaCO2 is proportional to

A

VCO2

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90
Q

PaCO2 is inversely proportional to

A

Va

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91
Q

with each subsequent minute of apnea

A

CO2 will increase exponentially

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92
Q

venous labs names

A

BMP
Chem 7
Electrolyte panel

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93
Q

venous sample includes which form of CO2

A

CO2
HCO3-

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94
Q

tCO2

A

venous CO2 (CO2 + HCO3-)

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95
Q

normal Venous CO2/HCO3-

A

24-30 mEq/L

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96
Q

normal arterial HCO3-

A

22-26 mEq/L

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97
Q

PAO2

A

partial pressure of O2 in the alveoli

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98
Q

PAO2 is determined by

A

FiO2
barometric pressure

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99
Q

PAO2 is minimally effected by

A

minute venilation

100
Q

incr barometric pressure causes _____ FiO2

A

incr FiO2

101
Q

can you measure PAO2

A

no - you can calculate it

102
Q

PaO2

A

partial pressure of O2 dissolved in the arteries

103
Q

PaO2 is what % of total body O2

A

1.5%

104
Q

what determines PaO2

A

PAO2

105
Q

PaO2 is not affected by

A

[Hb]
SaO2
CarboxyHb
MetHb
CyanoHb

106
Q

normal PaO2 on room ari

A

80-100 mmHg

107
Q

PaO2 estimate

A

5*FiO2

108
Q

how to measure PaO2

A

blood sample

109
Q

SaO2

A

% of Hb saturate w/O2

110
Q

SaO2 measured

A

blood sample
pulse ox

111
Q

SaO2 represents what % if total body O2

A

98.5%

112
Q

what is SaO2 primarily determined by

A

PaO2

113
Q

effect of CarboxyHb and MetHb on SaO2

A

decreases SaO2

114
Q

right shift

A

Hb bind less tightly

115
Q

left shift

A

Hb bind more tightly

116
Q

right shift causes

A

acidosis
hypercarbia
hyperthermia
anemia
incr 2,3-DPG

117
Q

left shift causes

A

alkalosis
hypocarbia
hypthermia
carboxyhb
methb

118
Q

supp O2 effect on PAO2

A

incr PAO2
== incr PaO2
== incr SaO2

119
Q

calculating PAO2 allows for assessment of

A

lung function

120
Q

A-a gradient

A

PAO2 compared to PaO2

121
Q

normal A-a gradient

A

5-15 mmhg

122
Q

wide A-a gradient

A

> 15 mmHg

123
Q

wide A-a gradient indicates

A

impaired gas exchange
or
increased R-L pulm shunting

124
Q

normal A-a gradient indicates

A

normal lung function

125
Q

equation used to calculat PAO2

A

alveolar gas equation

126
Q

PAO2 =

A

PAO2 = PiO2 - (1.2)(PaCO2)

== PAO2 = (FiO2)(Pb-WVP) - 1.2*PaCO2

    == PAO2 = (FiO2*713) - 1.2*PaCO2 
           (sea level)
127
Q

primary determinant of PAO2

A

FiO2

128
Q

PAO2 estimation

A

PAO2 ~ 102 - [age/3]

129
Q

normal PaO2/FiO2 ratio

A

> 400

130
Q

does PaO2/FiO2 vary with supp O2

A

nope

131
Q

ALI PaO2/FiO2

A

< 300

132
Q

ARDS PaO2/FiO2

A

< 200

133
Q

CaO2 =

A

CaO2 = SaO2Hb1.34 + PaO2*0.003

134
Q

what factors contribute to total arterial O2 content

A

PaO2
SaO2
Hb

135
Q

which has a greater effect on CaO2: SaO2 or Hb

A

equal effect

136
Q

which has a greater effect on CaO2: SaO2 or PaO2

A

SaO2

137
Q

CvO2 =

A

CvO2 = (SvO2)Hb1.34 + PvO2*0.003

138
Q

normal SvO2

A

70-75%
(draw off central line)

139
Q

VO2 =

A

VO2 = CO(CaO2-CvO2)10

140
Q

DO2

A

delivery of O2
amount of O2 available to tissue perfusion per minute

141
Q

DO2 =

A

DO2 = CaO2CO10

142
Q

DO2 is mostly dependent on

A

SaO2 and Hb

143
Q

DO2 is minimally dependent on

A

PaO2

144
Q

DO2 units

A

mL/L

145
Q

hyper/hypoventilation refer to

A

CO2 removal not respiratory rate

146
Q

hypoxia

A

impaired O2 perfusion

147
Q

hypoxemia

A

decr in blood O2 content (CaO2)

148
Q

hypoxemia hypoxia

A

hypoxia due to reduced arterial O2 saturation (SaO2)

149
Q

anemic hypoxia

A

hypoxia due to decr [Hb] which leads to decr total O2 content in blood (CaO2)

normal SaO2

150
Q

anemic hypoxia SaO2

A

normal

151
Q

ischemic hypoxia

A

hypoxia due to decr blood flow to the tissues

152
Q

causes of ischemic hypoxia

A

low CO
hypovolemia
severe vasoconstriction
etc

153
Q

histotoxic/cytotoxic hypoxia

A

hypoxia due to inability of tissues to take up or use the O2 from the bloodstream

normal blood content
normal O2 delivery

154
Q

causes of histotoxic/cytotoxic hypoxia

A

cyanide poisoning
carbon monixide posioning
methemoglobinemia
septic shock
impaired mitochondrial function

155
Q

what happens to cerebral blood flow in hypoxic pt?

A

cerebral blood flow increases to deliver more O2 to brain

156
Q

what pts should hypoxia be avoided in?

A

pts w/closed head injury
pts w/increased ICP

157
Q

below what PaO2 does cerebral BF increase rapidly?

A

60 mmHg

158
Q

Bohr effect

A

O2 being displaced from Hb as PaCO2 increases

159
Q

Haldane effect

A

CO2 being displaced from Hb as O2 concentration increases

160
Q

what Hb is more affinitive for CO2

A

deoxy Hb in peripheral veins

161
Q

what Hb is less affinitive for CO2

A

oxy Hb in pulm capillaries

162
Q

respiratory acidosis

A

incr PaCO2

163
Q

respiratory acidosis diagnosis

A

low pH
high PaCO2

164
Q

respiratory acidosis compensation

A

kidneys reabsorb HCO3- causing
1) incr HCO3-
2) incr pH
3) incr PaCO2

165
Q

respiratory acidosis treatment

A

incr pt MV

166
Q

respiratory alkalosis

A

decr PaCO2

167
Q

respiratory alkalosis diagnosis

A

high pH
low PaCO2

168
Q

respiratory alkalosis compensation

A

kidnesy excrete HCO3- causing
1) decr HCO3-
2) decr pH
3) decr PaCO2

169
Q

respiratory alkalosis treatment

A

decr MV

170
Q

metabolic acidosis

A

decr HCO3-k

171
Q

metabolic acidosis diagnosis

A

low pH
low HCO3-

172
Q

metabolic acidosis compensation

A

pt hyperventilates causing
1) decr PaCO2
2) incr pH
3) decr HCO3-

173
Q

metabolic acidosis treatment

A

give bicarb

174
Q

bicarb dosing

A

0.3weightbase excess

175
Q

metabolic alkalosis

A

incr HCO3-

176
Q

metabolic alkalosis diagnosis

A

high pH
high HCO3-

177
Q

metabolic alkalosis compensation

A

pt hypoventilates causing
1) incr PaCO2
2) decr pH
3) incr HCO3-

178
Q

metabolic alkalosis treatment

A

reverse the cause

179
Q

normal PaCO2

A

40 mmHg

180
Q

normal HCO3-

A

24 mEq/L

181
Q

in respiratory acidosis, for each 10 mmHg increase in PaCO2: acute HCO3- effects

A

HCO3- incr 1 mEq/L (acute)

182
Q

in respiratory acidosis, for each 10 mmHg increase in PaCO2: chronic HCO3- effects

A

HCO3- incr 4 mEq/L (chronic)

183
Q

in respiratory alkalosis, for each 10 mmHg decrease in PaCO2: acute HCO3- effects

A

HCO3- decr 2 mEq/L

184
Q

in respiratory alkalosis, for each 10 mmHg decrease in PaCO2: chronic HCO3- effects

A

HCO3- decr 4 mEq/L

185
Q

in metabolic acidosis, PaCO2 should

A

PaCO2 should decrease 1.2x the HCO3- decrease

186
Q

in metabolic alkalosis, PaCO2 should

A

PaCO2 should increase 0.7x the HCO3- increase

187
Q

if pt has a respiratory distrubance, the body adjusts

A

HCO3-

188
Q

if pt has metabolic disturbance, the body adjusts

A

PaCO2

189
Q

routinely measured cations

A

Na+
K+

190
Q

routinely measured anions

A

HCO3-
Cl-

191
Q

plasma charge

A

neutral

192
Q

“anion gap”

A

difference in the number of measured cations and measured anions

193
Q

2 ways to calculated AG

A
  1. AG = measured Cat - measured anions
  2. AG= unmeasured anions - unmeasured cations
194
Q

AG =

A

AG = (Na+ + K+) - (HCO3 + Cl-)

195
Q

what can be omitted from AG equaation

A

K+
(relatively small)

196
Q

AG ==

A

AG = Na+ - (HCO3- + Cl-)

197
Q

normal AG

A

12 +/- 4 mEq/L

198
Q

anion gap increases if (4)

A
  1. # measured cations incr
  2. # measured anions decr
  3. # unmeasured anions incr
  4. # unmeasured cations decr
199
Q

anion gap decreases if (4)

A
  1. # measured cations decr
  2. # measured anions incr
  3. # unmeasured anions decr
  4. # unmeasured cations incr
200
Q

why is anion gap useful

A

helps with differential diagnosis of disease states

201
Q

lactic acidosis anion gap

A

high (widen) anion gap acidosis

202
Q

lactic acid breaks down into

A

lactate
H+

203
Q

why does lactic acidosis incr anion gap?

A
  1. incr unmeasured anions (lactate)
  2. decr measured anions (HCO3- binding H+)
204
Q

excess NaCl

A

hyperchloremic
acidotic
start losing base

205
Q

normal anion gap acidosis (2)

A
  1. direct loss of HCO3-
  2. incr [Cl-]
206
Q

common cause of direct HCO3- loss

A

GI (diarrhea)
renal dysfunction

207
Q

common cause of hyperchloremic metabolic acidosis

A

excess 0.9% N/S

208
Q

low anion gap acidosis

A
209
Q

low anion gap alkalosis

A

hypoalbuminemia
loss of albumin (-)
retention of HCO3-/Cl-

210
Q

DKA pts most likely have

A

T1D

211
Q

what causes DKA

A

lack of insulin

212
Q

what does lack of insulin cause

A

cells break down fats in order to create sugar
== produced ketone bodies

213
Q

are ketone bodies acids or bases

A

acids

214
Q

what happens when blood sugar gets too high

A

kidneys cant keep up with filtration
– sugar spills into renal tubules
– incr osmotic diuresis
– hypovolemia

215
Q

what should we give with insulin

A

K+

216
Q

DKA symptoms

A
  1. hyperkalemia
  2. acidosis
  3. hypovolemia
  4. K+ disturbnaces
  5. Na+ disturbances
  6. hyperosmlarity
217
Q

hyponatremia is seen in what amount of pts with DKA

A

2/3

218
Q

DKA: K+ disturbance

A

hyperkalemia most common

219
Q

DKA: Na+ disturbance

A

hyponatremia most common

220
Q

DKA treatment

A
  1. admin insulin
  2. K+ infusion
  3. add glu w/insulin infusion
  4. give bicarb
  5. fluid resuscitation
221
Q

when do you give insulin

A

K+ > 3.3 mEq/L

222
Q

what should you correct prior to starting insulin therapy?

A

correct K+ level

223
Q

when should you start adding glu to insulin infusion

A

glu = 250-300 mg/dL

224
Q

glucose insulin infusion dosing

A

1 unit insulin per 5g glu

(5 units insulin per amp D50)

225
Q

how much fluid is lost in DKA

A

6-9L

226
Q

how much fluid should be replaced in DKA

A

total volume of loss within 24-36 hrs

227
Q

how much fluid is given in DKA resucitation during the first 8-12 hrs

A

50% of volume

228
Q

which fluid for DKA resuscitation?

A

crystalloid
- NS more popular than LR due to hyponatremia

229
Q

air in blood sample: CO2 diffusion

A

CO2 diffuse OUT of blood INTO air

230
Q

air in blood sample PaCO2

A

falsely lowerd PaCO2 reading

231
Q

pt on 100% O2
air in blood: O2 diffusion

A

O2 diffuse OUT of blood INTO air

232
Q
  • pt on 100% O2*
    air in blood PaO2
A

falsely lowerd PaO2 reading

233
Q

pt on room air
air in blood: O2 diffusion

A

O2 diffuse OUR of air INTO blood

234
Q

pt on room air
air in blood: PaO2

A

falsely elecated PaO2

235
Q

blood samples colder than 37C

A

wil be warmed

236
Q

blood samples warmer than 37C

A

will be cooled

237
Q

what happens to PaO2 and PaCO2 when blood is warmed

A

PaO2 Incr
PaCO2 incr

238
Q

what happens to PaO2 and PaCO2 when blood is cooled

A

PaO2 decr
PaCO2 decr

239
Q

cold blood samples have

A

falsely elevated PaO2/PaCO2

240
Q

warm blood samples have

A

falsely lowered PaO2/PaCO2

241
Q

pregnancy PaO2

A

increases
(due to incr MV)

242
Q

pregnancy pH

A

increases
(due to incr MV and resp alkalosis)

243
Q

pregnancy HCO3-

A

decreases

244
Q

neonate pH

A

lower
(7.2)

245
Q

neonate PaO2

A

lower
50-80 mmHg

246
Q

neonate PaCO2

A

normal
35-45 mmhg

247
Q
A

Fa: Methods 2 (16 decks)

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