Acid-base

Question 1

Respiratory Acidosis

Answer 1

• body accumulates CO2 and cannot eliminate (hypercapnia)
• pH: <7.35
• PaCO2: >45mmHg
  causes: COPD, pneumonia, airway obstruction, pulmonary edema, drug-overdose (anesthetic)

Question 2

Respiratory Acidosis Compensation

Answer 2

• Kidney: increase reabsorption of HCO3
• excrete H+
• bicarb level > be 26
• use bronchodilators

Question 3

Respiratory Alkalosis

Answer 3

• CO2 <35mmHg (hypocapnia)
• pH: >7.45
• causes: hyperventilation (>20/min), hypoxemia, hyper metabolic state, early salicylate intoxication, hysteria

Question 4

Respiratory Alkalosis Compensation

Answer 4

• kidney decreases H+ excretion and increase HCO3 excretion
• restrict O2 intake
• paper bag breathing
• pain management
• HCO3: <22

Question 5

Metabolic Acidosis

Answer 5

• bicarbonate loss
• increase of non-carbonic acids
• pH: <7.35
• HCO3: <22
• PaCO2: maybe normal
• causes: ketoacidosis, lactic acidosis, salicylates ingestion

Question 6

Metabolic Acidosis Compensation

Answer 6

• lungs: increase respiratory rate to release H+
• treat with sodium bicarbonate
• treat underlying cause
• PaCO2: <35

Question 7

Metabolic Alkalosis

Answer 7

• increase in HCO3 intake
• pH: >7.45
• HCO3: >26
• causes: bicarb ingestion, excess IV bicarb, loss of gastric fluid, Cushing syndrome, hyperaldosteronism, diuretics

Question 8

Metabolic Alkalosis Compensation

Answer 8

• lungs: slow breathing
• kidney reabsorb H and excrete bicarb
• treat with electrolyte and fluids
• underlying cause
• PaCO2: >45

Question 9

Hypernatremia

Answer 9

• Na > 145mEq/L
• retention/infusion of sodium: excretion of water
• over secretion of ACTH&raquo_space; increase aldosterone
• leads to intracellular dehydration
• s/s: weight gain, increased BP
• CNS affection: confusion, coma, convulsion

treatment: oral fluids, IV fluids

Question 10

hyponatremia

Answer 10

• Na < 135
• loss of sodium, inadequate intake, excess water intake, excess secretion of ADH (SIADH)
• vomiting, diarrhea, suctioning of GI secretions, diuretics

treatment; hypertonic saline, restrict water intake

Question 11

hyperkalemia

Answer 11

causes
- increased intake (rare), potassium shift from cells to ECF, drugs that decrease renal potassium excretion (ACE inhibitors; ARBs), renal failure
S/S
- numbness or tingling of extremities, muscle cramping, diarrhea, EKG wide QRS, peaked T wave, irregular pulse, cardiac arrest
treatment
- monitored in renal failure, trauma, insulin deficiency, addison’s disease
- sodium polystyrene sulfonate (poop to excrete)

Question 12

hypokalemia

Answer 12

causes
- diuretic therapy (most common), diarrhea, intestinal drainage, vomiting, inadequate intake (alcoholics, eating disorder, NPO)
S/S: anorexia, N/V, sluggish bowel, muscle fatigue, arrhythmias, leg cramps
treatment
- potassium supplement: IV or mouth