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PHRM 864: Therapeutics IV > Acid/Base > Flashcards

Acid/Base Flashcards

1
Q

What is the normal range for pH?

A
  • 7.35-7.45 [<6.7 or >7.7 is BAD for life]
  • <7.35 is acidosis & >7.45 is alkalosis
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2
Q

How do we know when an acid-base disorder affects a certain organ?

A
  • Metabolic = Kidney [Lungs compensate]
  • Respiratory = Lungs [Kidneys compensate]
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3
Q

What are the normal blood gas levels [arterial blood]?

A
  • PaCO2 = 35-45 mmHg [“40”]
  • HCO3 = 22-26 mEq/L [“24”]
  • PaO2 = 95-100 mmHg
  • SaO2 = >95%
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4
Q

What are some of the adverse consequences for Acidemia?

A
  • Cardiovascular
  • Metabolic
  • CNS
  • Other
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5
Q

What are some of the Cardiovascular Adverse Events for Acidemia?

A
  • DECREASE Cardiac Output [heart isnt pumping]
  • Impaired contractility
  • INCREASE vascular resistance
  • Arrhythmia [Related toward metabolic]
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6
Q

What are some of the Metabolic Adverse Events for Acidemia?

A
  • Insulin Resistance
  • INHIBTION of anaerobic glycolysis
  • HYPERkalemia [cardio]
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7
Q

What are some of the CNS Adverse Events for Acidemia?

A
  • Coma
  • Altered mental status
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8
Q

What are some of the Other Adverse Events for Acidemia?

A
  • Decreased respiratory muscle strength
  • HYPERVENTATION
  • SOB
  • N/V
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9
Q

What are some adverse consequences for Alkalosis?

A
  • Cardiovascular
  • Metabolic
  • CNS
  • Other
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10
Q

What are some of the cardiovascular adverse events for Alkalosis?

A
  • DECREASE blood flow
  • Decreased anginal thershold
  • Arrhythmia [related toward metabolic]
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11
Q

What are some of the Metabolic adverse events for alkalosis?

A
  • DECREASE K, Ca, Mg
  • Stimulation of Anaerobic glycolysis
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12
Q

What are some of the CNS adverse events for alkalosis?

A
  • Lethargy, Delirium, Stupor, Seizures
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13
Q

What are some of the Other adverse events for Alkalosis?

A
  • DECRASED respirations
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14
Q

What are the three [four-ish] standards mechanisms for acid-base regulation?

A
  • Buffering
  • Renal Regulation
  • Ventilatory Regulation
  • [Hepatic Regulation]
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15
Q

What is important to know about the buffering mechanisms?

A
  • FIRST LINE defense
  • Buffers: Bicarb, Phosphate, Proteins
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16
Q

What is important to know about Bicarb in the buffering mechanism?

A
  • RAPID ONSET with intermediate capacity
  • HCO3 has the largest conc. [CO2 is unlimited]
  • Controlled by HCO3 & CO2 [kidneys & lungs]
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17
Q

What happens when there is acid added?

What does this mean?

A
  • Large quantities of CO2 gets exhaled rapidly
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18
Q

What is important to know about Phosphate in the buffering mechanism?

A
  • INTERMEDIATE ONSET and capacity
  • Limited activity
  • Ca/P in is the bone [must be broken down to get = bad to do]
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19
Q

What are the ways that the renal system regulation?

A
  • Bicarb Reabsorption [reabsorb]
  • Ammonium Excretion & Titratable Acidity [new]
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20
Q

Briefly describe what happens in the Bicarb Reabsorption pathway?

A
  • HCO3 [lumen] combines with H [cell] making H2CO3
  • H2CO3 splits into CO2 & H2O
  • CO2 & H2O reabsorbs into cell to make H2CO3
  • H2CO3 makes HCO3, absorbing to blood stream
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21
Q

Where does the Bicarb Reabsorption Pathway take place?

A
  • Proximal Tubule [85-90%]
  • Filters 4000-4500 mEq
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22
Q

What is important to know about the Carbonic Anhydrase Inhibitors in the Bicarb Reabsorption Pathway?

A
  • It blocks the inhibition of H2CO3 breakdown; decreasing HCO3
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23
Q

Briefly describe what happens in the Bicarb generation pathway [ammonium & titrable]?

A
  • Ammonium: H combines NH3 = NH4; HCO3 [cell] reabsorbs into the blood stream [300 mEq/d]
  • Titratable: H combines HPO4 = H2PO4; HCO3 [cell] reabsorbs into the blood stream [40 mEq/d]
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24
Q

Where does the Bicarb Generation Pathway take place?

A
  • Distal Tubule
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25
Q

What is important to know about the Ventilatory Regulation ?

A
  • RAPID ONSET and LARGE CAPACITY
  • Chemoreceptors detect increase in PaCO2 = increased respirations [blowing off CO2]
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26
Q

What is important to know about the Hepatic Regulation?

A
  • NEW maybe in times of acidosis the liver shutdown urea; pushing it towards alkalosis
27
Q

What is teh compensation charateristics for acid-base disorders?

A
  • Mac: D HCO3 = D PaCO2 [increased breathing]
  • Malk: I HCO3 = I PaCO2 [decreased breathing]
  • Rac: I PaCO2 = I HCO3 [Kidneys compensate]
  • Ralk: D PaCO2 = D HCO3 [Kidneys compensate]
28
Q

What are the acid-base disorders?-

A
  • Metabolic Acidosis
  • Metabolic Alkalosis
  • Respiratory Acidosis
  • Respiratory Alkalosis
29
Q

What are the characteristics of Metabolic Acidosis?

A
  • Low pH: < 7.35
  • Low HCO3: <24
  • Decreased PaCO3 [ventilation]
30
Q

What are the two types of Metabolic Acidosis?

A
  • Non-Anion Gap
  • Anion Gap
31
Q

What is the pathosiology of non-anion gap acidosis?

A
  • GI Bicarb Loss
  • Renal Bicarb Loss
  • Reduced Renal H Excretion
32
Q

What is important about GI Bicarb Loss in non-anion gap acidosis?

Side Effects?

A
  • Diarrhea: very common cause [lose 5-10 L of fluids (1 L has 30-50 mEq of HCO3)]
  • Fistulas - rich in bicarb [might lose HCO3]
33
Q

What is important about Renal Bicarb Loss in Non-anion gap acidosis?

A
  • Type II Renal Tubular Acidosis [Proximal]
  • Reabsorption of HCO3 in reduced in Proximal causing a loss in Na & Fluids = hypokalemia
34
Q

What is important about Reduced Renal H Excretion in non-anion gap acidosis?

A
  • Type I RTA [Hypokalemia]: H cannot go into lumen = increase K excretion
  • ## Type IV RTA [Hyperkalemia]: Decreased aldsterone = H retention; holding on to K= acidosis
35
Q

What is the Pathophysiology of Anion Gap acidosis [MULEPAK]?

A
  • M: Methanol Intoxication
  • U: Uremia
  • L: Lactic Acidosis
  • E: Ethylene Glycol
  • P: Paraldehyde Ingestion
  • A: Aspirin
  • K: Ketoacidosis
36
Q

After finding out the anion gap, what is the next thing that you should do?

A
  • Calculate the Delta Gap
  • DG = patients anion gap [Na - (Cl + HCO3)] - Normal Anion Gap
  • Delta Gap makes elevated HCO3 = Acidosis + Alkalosis
37
Q

What are the causes fo anion gap metabolic acidosis?

A
  • Lactic Acidosis [Most Common]
  • Ketoacidosis
  • Drug Interactions
38
Q

What is the importance of lactic acidosis in anion gap metabolic acidosis?

A

-most common for Anion
- Lactate is normally aroind 1meq/l but in Lactic Acidosis it ~5mEq/l

39
Q

What are the possible causes for Lactic Acidosis?

A
  • Shock [making more of it]
  • Drugs: [Ethanol, Warfarin, NRTIs (HIV meds), Propofol, Propylene Glycol]
  • Seizures: makes a lot
  • Leukemia
  • Hepatic/Renal Failure
  • Diabetes
40
Q

What is more likely to cause Drug Intoxication in anion gap metabolic acidosis?

A
  • Salicylates: increase respiration & increase acid [Respiratory Alkalosis & Metabolic Acidosis]
  • Methanol
  • Ethylene glycol
41
Q

What are the symptoms of Lactic Acidosis?

A
  • Kussmaul respiration [deep & rapid]
  • Tachycardia
  • HYPERkalemia
  • Lethargy/coma
  • N/V
42
Q

What is the treatment for Lactic Acidosis?

A
  • Treat underlying cause FIRST
  • Acute Bicarb Therapy [<7.10-7.15; Hyperkalemia; use 12 mEq/L –> give 1/3 to 1/2; supplement K]
43
Q

What are some of the hazard of Bicarb therapy?

A
  • Overalkanization: reduce cerebral flow
  • Hypernatremia
  • Eletrolyte shifts [Potassium: acidosis K moves out; added bicarb will move MORE K out & Calcium: cardio issues]
44
Q

What are the characteristics of Metabolic Alkalosis?

A
  • High pH: > 7.45
  • High HCO3
  • Increased PaCO2 [shallow breathing]
45
Q

What is the pathophysiology of Metabolic Alkalosis?

A
  • Rise in HCO3 b/c of loss of acid in the GI
  • Give too much Bicarb
  • Losing Cl-
46
Q

What are the two type of Metabolic Alkalosis?

A
  • Saline Responsive Alkalosis [
  • Saline Resistant Alkalosis [
47
Q

What are the causes of Saline Responsive Metabolic Alkalosis?

A
  • DIURETIC THERAPY [MOST COMMON]
  • Vomiting & NG Suction
  • Blood Transfusions
48
Q

What is important to know about Diuretic Therapy in Saline Responsive Metabolic Alkalosis?

A
  • MOST COMMON
  • Furosemide, Toresemide, Bumetanide, HCTZ
  • The excretion of NaCl stimulates aldosterone; increasing Na reabsorption and H & K secretion; H secretion = HCO3 reabsorption
49
Q

What is important to know about Vomiting & NG suction in Saline Responsive Metabolic Alkalosis?

A
  • 2nd MOST COMMON
  • 1L/d is lost from vomiting = 200mEq of Cl [losing Cl = Increased HCO3] & 25-100mEq H
50
Q

What is important to know about Blood transfusion in Saline Responsive Metabolic Alkalosis?

A
  • Involves Lactated Ringers, HCO3, TPN…
  • Citrate breaks down into HCO3
51
Q

What are the causes of Saline Resistant Metabolic Alkalosis?

A
  • NO drop in Cl
  • Increased Mineralocorticoid Activity [H secretion = increased HCO3]
  • HYPOkalemia [H secretion = increased HCO3]
  • Renal Tubular Cl Wasting [increased aldosterone = same as the diuretics]
52
Q

What are some of the symptoms for Saline Resistant Metabolic Alkalosis?

A
  • Muscle Cramps, Weakness [decreased K]
  • Mental Confusion, Coma, Seizures
  • Arrhythmias
53
Q

What is the treatment for Saline Responsive Metabolic Alkalosis?

A
  • Give fluids [Na & Cl reabsorbed; increase K = decreased H; caution in HF]
  • Carbonic Anhydrase Inhibitors [Decreased HCO3 reabsorption; not good in severe alkalosis]
  • HCl Acid [for those with NA replacement or failure of therapies]
  • Ammonium Cl
  • Arginine Monohydrocholride [last line]
54
Q

What is the treatment options for Saline Resistant Metabolic Alkalosis?

A
  • CORRECT decreasing K
  • Decrease mineralocorticoid dose
  • Give spironolactone
55
Q

What are the two Respiratory Disorders in Acid Base?

A
  • Respiratory Acidosis
  • Respiratory Alkalosis
56
Q

What is the characteristics of Respiratory Acidosis?

A
  • Low pH: <7.35
  • Increased PaCO2
  • Increased HCO3
57
Q

What is the pathophysiology of Respiratory Acidosis?

A
  • “something blocking the airway; CO2 cant escape”
  • Airway Obstruction [Asthma, Foreign Body, Aspiration]
  • Reduced stimulus of Respiration [OD, Apena, Trama]
  • Heart or Lung Failure
  • CNS issues
  • Mechanical Vent
58
Q

What are the symptoms of Respiratory Acidosis?

A
  • Respiratory: SOB
  • CNS: HA, drowsiness, coma, seizures
  • CV: Tachycardia, Arrhythmias, HYPOtension
59
Q

What is the treatment for Respiratory Acidosis?

A
  • Mechanical Vent or Oxygen [Caution in COPD]
  • Maybe Bicarb if pH is 7.10-7.15
60
Q

What are the characteristics of Respiratory Alkalosis?

A
  • High pH: <7.45
  • Decreased PaCO2
  • Decreased HCO3
61
Q

What is the pathophyisology for Respiratory Alkalosis?

A
  • “Too much breathing”
  • Stimulation of respiration
  • Mechanical Vent [work too hard]
  • PE
  • Salicylate Intoxication [could cause Metabolic Acidosis & Respiratory Alkalosis]
62
Q

What are some of the symptoms for Respiratory Alkalosis?

A
  • CNS: Lightheadedness, Confusion, Seizures
  • decreased cerebral blood flow
  • muslce cramps
  • N/V
63
Q

What are some treatment options for Respiratory Alkalosis?

A
  • Ventilation
  • Sedation [b/c they are breathing too much]
  • Paralysis

PHRM 864: Therapeutics IV (28 decks)

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