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Foundations II- Nephrology > ABGs and Acid-Base > Flashcards

ABGs and Acid-Base Flashcards

1
Q

What is an ABG?

A

frequently used to detect and monitor indices of:

Oxygenation
Ventilation
Acid-base balance

also quantify levels of carboxyhemoglobin and methemoglobin

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2
Q

What can you also get quickly with an ABG?

A

H/H and lytes

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3
Q

How do we get ABGs?

A

blood drawn from an artery- usually radial

collected with an anticoagulant (heparin), put on ICE and take it to lab

quick! ~5 min

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4
Q

What’s on an ABG?

A 
ph 
pO2 
O2 sat 
PCO2 35-45mmHg
HCO3 22-26 mmol/L
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5
Q

What is pO2 used for?

A

determining how well the pt is oxygenating

more reliable than pulse ox

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6
Q

Role of Acids and Bases

A

both work as a buffer system

Body maintains precise control of hydrogen ions to maintain homeostasis

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7
Q

Acidemia? Alkalemia?

A

Ph <7.35

ph > 7.45

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8
Q

A primary respiratory problem involves….

primary metabolic problem involves…

A

pCO2

HCO3

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9
Q

If both pCO2 and HCO3 are HIGH …

A

respiratory acidosis or metabolic alkalosis

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10
Q

If both pCO2 and HCO3 are LOW …

A

respiratory alkalosis OR metabolic acidosis

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11
Q

If pCO2 and HCO3 are moving in opposite directions, there is a

A

mixed disorder present

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12
Q

Compensatory process in acid-base disorder

A

body tries to compensate for an acid-base disorder by using respiratory or metabolic processes that attempt to return a patient’s pH to normal

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13
Q

Causes Metabolic Acidosis?

A

high anion gap metabolic acidosis
- MUDPILES

non anion gap metabolic acidosis: GI bicarb loss, renal bicarb loss, hypercholeremia due to saline resuscitation

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14
Q

MUDPILES?

A

Causes for metabolic acidosis with high anion gap:

Methanol
Uremia
DKA
Propylene Glycol
Iron/Isoniazid
Lactate (lactic acidosis)
Ethanol/ethylene glycol
Salicylates/starvation
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15
Q

Tx for metabolic acidosis?

A

treat underlying cause!!

+/- sodium bicarb to temporarily help

allow for norm. respiratory compensation

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16
Q

What is renal tubular acidosis (RTA)?

A

RTA is a family of syndromes of metabolic acidosis from defects in tubular H+ secretion and urinary acidification.
Relatively uncommon

metabolic acidosis and NORM anion gap

17
Q

What are the 2 types of RTA?

A

Failure to reabsorb filtered HCO3 (Type 2)

Failure to excrete H+ (Type 1)

18
Q

Describe type 1 RTA, tx?

A

(distal)
Most often caused by autoimmune disease and hypercalciuria. Can also be genetic.

correct metabolic acidosis

potassium citrate if persistent hypokalemia

19
Q

Describe type 2 RTA, tx?

A

Isolated defect in proximal bicarb reabsorption or in association with other defects in the proximal tubular function that impair reabsorption of other solutes

Correct acidemia
May need Vit D and phosphate supplements
+/- Thiazide diuretics

20
Q

Tx of metabolic alkalosis if urine chloride <25?

if >25?

A

give fluids!

tx underlying cause, may need K

21
Q

Describe respiratory acidosis

A

not able to ventilate well enough, leading to an accumulation of CO2

22
Q

Causes of respiratory acidosis?

A

acute airway obstruction

lung disease i.e. COPD, pna

CNS depression i.e. drugs (narcotics), CNS event

Neuromuscular disorder i.e. MG, GBS

23
Q

Tx for respiratory acidosis?

A

tx underlying cause

res. support - BIPAP
- determine if acute or chronic

24
Q

What is respiratory alkalosis

A

excressive elimination of CO2 from lungs

CO2 <35

sxs: lighheadness, palpitation, tachypnea, +/- paresthesias

25
Q

What are some causes of respiratory alkalosis?

A

hyperventilation, anxiety
compensatory in sepsis
pain
CNS, etc.

26
Q

How do you determine primary acid-base disorder?

A

look at PH!!

27
Q

How can you tell if pt is compensating?

A

If ph is close to normal

28
Q

How do you calculate anion gap?

A

Na -(Cl + HCO3)

normal: 8-12mmol/L

29
Q

Anytime you have a very high anion gap greater than …… there automatically has to be a primary metabolic acidosis,

A

20

30
Q

Does a normal Ph mean that you don’t have an acid base disorder?

A

NO

could be compensated

31
Q

low bicarb is usually…

A

pathologic

make sure you investigate it

32
Q

Causes of metabolic alkalosis w/ urine chloride < 25

A

GI losses (vomiting)
Diuretics (“contraction alkalosis”)
Cystic fibrosis

33
Q

Causes of metabolic alkalosis w/ urine chloride > 25

A 
Barter's 
Cushing's
Hyperaldosteronism 
K depletion
Citrate toxicity 
Chronic diuretics 
Renin secreting tumor

Foundations II- Nephrology (7 decks)

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