abg'S Flashcards
1
Q
ROME
A
RESP opposite, Metabolic equal
2
Q
Increased pH, decreased CO2 =
A
resp alkalosis
3
Q
decreased pH, increased CO2=
A
resp acidosis
4
Q
Increased pH, Increased HCO3 =
A
metabolic alkalosis
5
Q
decreased pH, decreased HCO3=
A
metabolic acidosis
6
Q
compensated:
A
pH is normal
7
Q
Uncompensated:
A
ph is not normal
8
Q
partially uncompensated:
A
nothing is normal
9
Q
normal pH values:
A
7.35 -7.45
10
Q
normal CO2 values:
A
35-45
11
Q
normal HCO3 values:
A
22-26
12
Q
Kussmals respirations
A
metabolic acidosis
13
Q
HYPOVentilation
A
Resp acidosis
14
Q
HYPERventilation
A
Resp alkalosis
15
Q
increased K
A
Acidosis
16
Q
decreased K
A
alkalosis
17
Q
N/V/D typically associated with
A
Metabolic acidosis or alkalosis
18
Q
Anion gap elevation found in
A
metabolic acidosis
19
Q
Metabolic Acidosis Tx
A
sodium bicarb
decrease BG
Treat underlying Cause:
Lactic Acidosis, DKA, Uremia
20
Q
Metabolic Alkalosis TX
A
correct underlying cause Replace K (and other electrolytes) Acetazolamide Spironolactone Dialysis
21
Q
Respiratory Acidosis TX
A
Increase MV (RR) Improve ventilation w/better tissue perfusion
22
Q
Respiratory Alkalosis TX
A
Decrease MV (RR) "Breathing in paper bag" --> retain CO2
23
Q
Causes of Resp. Alkalosis
A
Hyperventilation mechanical over-ventilation High Altitudes anxiety ARDS PE hypoxia fever sepsis pain pregnancy brain tumor
24
Q
Causes for Resp Acidosis
A
HYPOventilation /resp depression Pulm edema PNA Asthma/ COPD/ Fibrosis airway obstruction Drug OD Pneumothorax MS or other NMD's Stroke Head injury/ CNS depression Cardiac Arrest Rebreathing - exhausted CO2 absorber; incompetent one=way valve
25
Causes for Metabolic Alkalosis
```
Lost of Gastric Juices: vomiting or suctioning
Potassium wasting diuretics
MASSIVE TRANSFUSIONS
Hypokalemia
Hypercalcemia
Antacid overuse
use of steroids
Excessive NaHCO3
Increased mineralocorticoid - CUSHINGS SYNDROME, and HYPERALDOSTERONISM
```
26
Causes for Metabolic Acidosis
```
Shock
Sepsis
DKA
starvation
Alcoholism
Salicylate toxicity
Diarrhea
RF
Hyperkalemia
Pancreatic / Lower GI Fistulas
```
27
Patient says " I can't catch my breath"... likely condition
Respiratory Acidosis = Increased CO2
28
Retention of CO2 by the lungs
Resp Acidosis
29
Muscle weakness typically associated with
Resp Acidosis
30
Muscle cramping and hyper reflexes are typically associated with
Resp Alkalosis
31
Muscle twitching typically associated with
Met acidosis
32
Lethargy, tremors, cramps, tingling, restless are likely associated with
met alkalosis
33
anxiety, irritability, and seizures may be associated with
resp alkalosis
34
Pale skin and mucosa, cyanosis can be found in
resp acidosis
35
warm flushed skin likely associated with
metabolic acidosis
| *vasodilation
36
Elevated K associated with
acidosis
37
How is your K with alkalosis ?
low K
38
Compensatory Hypoventilation
Metabolic Alkalosis
39
Compensatory Hyperventilation
Metabolic Acidosis
| *Kussmaul Respiration*
40
Large volume resuscitation with a NaCl solution associated with
Metabolic Acidosis
41
Anion Gap formula=
Na+ - (Cl- + HCO3-) = 8-12 mEq/L
Major cations - major anions = anion gap
42
Anion Gap Acidosis is
anion gap >14
| accumulation of acid
43
Non-gap acidosis is
anion gap < 14
| loss of bicarbonate or ECF dilution
44
mnemonic for gap acidosis:
"MUDPILES"
45
mnemonic for non-gap acidosis:
"HARDUP"
46
Normal anion gap =
8-12 mEq/L
47
MUDPILES
```
Gap Acidosis (>14):
M-methanol
U-uremia
D-DKA
P-paraldhyde
I-Isoniazid
L-Lactate (sepsis; cyanide poisoning)
E-Ethanol, Ethylene glycol
S-salicylates (inhibit krebs cycle)
```
48
HARD UP
```
Non-gap acidosis (<14):
H-HYPOaldosteronism
A-Acetazolamide
R-Renal tubular acidosis
D-Diarrhea or DROWNed in fluids
U-ureterosigmoid fistula
P-pancreatic fistula
```
49
Decreased P50 or LEFT shift
resp alkalosis
50
Would you correct PaCO2 in the pt with chronic respiratory acidosis (COPD)?
No. (in resp acidosis)
these pts normally retain bicarbonate and if you return their Co2 to normal then you've created metabolic alkalosis
51
Metabolic compensation for resp alkalosis?
kidneys excrete HCO3- to return pH to normal
52
Metabolic compensation for Resp acidosis?
kidneys excrete H
| conserve HCO3
53
Respiratory compensation for Metabolic acidosis?
PaCO2 decreases as a function of increased Mv (increased RR) ; hyperventilation ; kussmaul
54
Respiratory compensation for metabolic alkalosis?
PaCO2 increases as a function of decreased Mv.
| hypoventilation/decreased RR
55
PaCO2 decreases 1-1.5mmHg for every
HCO3 decrease of 1 mEq/L
56
PaCO2 increased 0.5-1 for every
HCO3 increase of 1 mEq/L
57
Tx for Lactic acidosis
IVF
O2
cardiopulm support
58
Tx for DKA
IVF and insulin
59
Tx for uremia or drug induced (met acidosis)
HD
60
what is Acetazolamide?
carbonic anhydrase inhibitor
| -increases renal excretion of HCO3-
61
what is spironolactone?
a mineralocorticoid antagonist
62
hypercarbia on brain
vasodilation
63
hypercarbia on lungs
vasoconstriction
64
Increased P50 shifts curve?
to the RIGHT --> releases more O2 to tissues
65
CO2 stimulates the SNS to increase release of
catecholamines
- increased HR, vasoconstriction, SVR
- increased O2 consumption
- increased demand on heart
- increased risk for MI
66
increased K activates
H+/K+ pump
| -buffers CO2 acid in exchange for releasing K into the plasma
67
increased Ca++ competes with
H+ for binding sites on plasma proteins
-acidosis: plasma pr buffer H+ and release Ca++ --> increasing inotropy
-alkalosis: plasma pr release H+ and bind Ca++ --> decreasing inotropy
68
inotropy means
force of contraction
69
CO2 freely diffuses across the
BBB
- decreased CSF pH -> decreased Cerebrovascular resistance => increased CBF and ICP
- increased CSF ph -->cerebral vasoconstriction ==> decreased CBF and ICP
70
CO2 narcosis when PaCO2
>90 mmHg
71
Henderson-Hasselbalch equation =
pH = pK + log [A-] / [HA]
or
pH = pK + log [HCO3-] / [CO2]
72
Buffer Systems help to mitigate
pH changes
73
Name the 3 buffer systems:
1. Blood (HCO3 , Hgb)
2. Respiratory compensation (PaCO2 alterations)
3. Renal compensation:
- reabsorption of HCO3
- removal of titratable acids
- formation of ammonia
