Acid Base

Question 1

Acid-Base Regulation

Answer 1

Buffer system (immediate)
Respiratory system (minutes to hours)
Renal system (2-3 days)

Question 2

Buffer system

Answer 2

Electrolyte exchange in cells (K-H)

Major organs (lungs and kidneys)

Lungs - CO2
Kidneys - acids and bicarbonate

Question 3

Alkalosis

Answer 3

hypokalemia

Question 4

Acidosis

Answer 4

Hyperkalemia

Question 5

kidneys

Answer 5

excrete H+ and reabsorb HCO3 to increase pH in respiratory acidosis

Question 6

Respiratory Acidosis

Causes

Answer 6

• COPD or asthma
• barbituate or sedative overdose
• severe pneumonia
• Atelectasis
• Respiratory muscle weakness
• mechanical hypoventilation
• sleep apnea
• head trauma
• post operative
• CNS depression

Increased PCO2 and decreased pH if uncompensated

Question 7

Respiratory Acidosis

Manifestations

Answer 7

• Neurological – drowsiness, disorientation, dizziness, headache, coma
• Cardiovascular – ↓BP; ventricular fibrillation; warm, flushed skin (peripheral vasodilation)
• GI – no significant findings
• Neuromuscular – seizures
• Respiratory - dyspnea, hypoventilation with hypoxia

Question 8

Respiratory Acidosis

Interventions

Answer 8

Treat underlying cause: opioids, oxygen therapy

Question 9

Respiratory Alkalosis

Causes

Answer 9

• Anything causing hyperventilation: hypoxia, fear/anxiety, fever, Fast resps
• Stimulated respiratory center: CNS disorders, sepsis, brain injury, salicylate poisoning
• Mechanical overventilation

Decreased PaCO2 and increased pH if uncompensated

Question 10

Respiratory Alkalosis

Manifestations

Answer 10

• Neurological – lethargy, lightheadedness, confusion
• Cardiovascular – increased HR; dysrhythmias
• GI - nausea, vomiting, epigastric pain
• Neuromuscular – tetany (muscle contraction), numbness, tingling of extremities, hyperreflexia, seizures
• Respiratory – rapid, shallow breathing

Question 11

Respiratory Alkalosis

Interventions

Answer 11

Treat underlying cause: rebreather mask, assist client to slow resps, decrease anxiety, oxygen therapy if hypoxia is the underlying cause

monitor VS, ABGs and electrolyte imbalances

Question 12

Metabolic Acidosis

Causes

Answer 12

Accumulation of acid: DKA, septic shock (lactic acid accumulation), starvation, renal failure, diarrhea
Loss of bicarbonate: diarrhea, renal failure

Decreased HCO and decreased pH if uncompensated

Question 13

Metabolic acidosis

Manifestations

Answer 13

• Neurological – drowsiness, confusion, headache, coma
• Cardiovascular - ↓ BP; dysrhythmias; warm, flushed skin (peripheral vasodilation)
• GI – nausea, vomiting, diarrhea, abdominal pain
• Neuromuscular – no significant findings
• Respiratory – deep, rapid respirations (Kussmaul’s respiration)
Interventions
• Treat underlying cause
• Respiratory support
• Administer sodium bicarbonate (?) – IV to neutralize done later on

Question 14

Metabolic Alkalosis

Causes

Answer 14

Loss of acid: NG suctioning, prolonged vomiting, loss of K+ due to diuretic therapy
Gain in bicarbonate: ingestion of baking soda

Question 15

Metabolic Alkalosis

Manifestations

Answer 15

• Neurological – dizziness, irritability, nervousness, confusion
• CVS – tachycardia, dysrhythmias
• GI – anorexia, nausea, vomiting
• Neuromuscular – tremors, hypertonic muscles, muscle cramps, tetany, tingling of fingers & toes
• Respiratory – hypoventilation (↓RR)

Question 16

Metabolic Alkalosis

Interventions

Answer 16

Treat underlying cause: replace lost fluids and electrolytes (MG and K), support renal function (dialysis if needed)

Administer acetazolamide - promotes loss of bicarbonate in urine

Question 17

Mixed

Answer 17

2 or more simple disorders present at the same time

pH will depend on type, severity and acuity
(resp acidosis and metabolic alkalosis) 
Mixed acidosis (cardiopulmonary arrest)
Mixed Alkalosis (hyperventilating and NG suctioning)