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acid base Flashcards

1
Q

what is a normal pH?

A

7.4 (7.35-7.45)

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2
Q

how is pH regulated?

A

buffers (bicarbonate and carbon dioxide)
respiration (lungs)
metabolic (kidneys)

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3
Q

lower pH= more _____ (acidic/basic)

A

acidic

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4
Q

pH is the inverse of ___

A

how much acid (-log H)

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5
Q

definition of an acid

A

H+ donor

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6
Q

CO2 is ____

A

acid

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7
Q

definition of a base

A

H+ acceptor

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8
Q

HCO3- is ___

A

base

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9
Q

definition of buffer

A

ability of a weak acid + anion (base) conjugate pair to resist pH changes after the addition of a strong acid or base

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10
Q

role of carbonic anhydrase

A

enzyme that converts CO2 to carbonic acid

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11
Q

“emia” refers to

A

objective sign in the blood
(abnormal pH)

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12
Q

“osis” refers to

A

the disease process
(metabolic or respiratory process led to abnormal pH)

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13
Q

normal PaCO2

A

35-45

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14
Q

normal HCO3-

A

22-26

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15
Q

how is arterial blood gas documented

A

pH/PaCO2/PO2/HCO3/SaO2

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16
Q

disorder when pH < 7.35

A

acidemia

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17
Q

disorder when pH > 7.45

A

alkalemia

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18
Q

disorder when PCO2 < 35

A

respiratory alkalosis

19
Q

disorder when PCO2 > 45

A

respiratory acidosis

20
Q

disorder when HCO3- < 22

A

metabolic acidosis

21
Q

disorder when HCO3 > 26

A

metabolic alkalosis

22
Q

how do the lungs try to regulate pH?

A

they either “blow off” or retain CO2 by altering minute ventilation

23
Q

how do the kidneys try to regulate pH?

A

they either increase or decrease reabsorption of HCO3-

24
Q

how will the lungs try to compensate in metabolic alkalosis?

A

try to retain CO2 by decreasing minute ventilation to decrease the pH

25
Q

how will the lungs try to compensate in metabolic acidosis?

A

try to blow off CO2 by increasing minute ventilation to increase the pH

26
Q

how will the kidneys compensate for respiratory alkalosis?

A

try to absorb less bicarb to decrease the pH

27
Q

how will the kidneys compensate for respiratory acidosis?

A

try to retain bicarb to increase the pH

28
Q

what is anion gap

A

calculation used to find causes of metabolic acidosis

Na - (HCO3 + Cl)

normal range is 4-12

adjust for albumin: add 2.5 to gap for every 1g/dL of albumin below 4

29
Q

what if anion gap >12?

A

MUDPILES
Methanol
Uremia
Diabetic ketoacidosis
Propylene glycol
Ingestion
Lactic acidosis
Ethylene glycol
Salicylates

30
Q

what if anion gap normal?

A

USEDCAR
Ureteral diversion
Saline infusion
Exogenous acid
Diarrhea
Carbonic anhydrase inhibitors
Adrenal insufficiency
Renal tubular acidosis

31
Q

what are some signs of respiratory acidosis?

A

pH < 7.35
CO2 > 45
decreased respiratory rate (retaining acid)
altered mental status, tachycardia

32
Q

how to treat respiratory acidosis?

A

mechanical ventilation: make them breathe (hyperventilate them to get them to blow off CO2)
treat underlying cause (opiate antagonist, bronchodilators, etc)

33
Q

objective signs of metabolic acidosis

A

pH < 7.35
HCO3 < 22
hyperventilation (from lungs trying to compensate)
+/- elevated anion gap (MUDPILES if elevated, USEDCAR if normal)

34
Q

what are some potential causes of lactic acidosis?

A

increased oxygen demand (extreme exercise or seizures)
decreased oxygen delivery (hypotension, severe anemia, severe HF)
drugs (metformin and salicylates)
decreased lactate clearance (hypoperfusion, liver failure)
toxins (methanol, ethanol)

35
Q

treatment of metabolic acidosis

A
  1. correct the underlying cause (whether that is gap or non gap. examples: give antidote, give insulin, dialysis)
  2. give some base: IV sodium bicarbonate in SEVERE cases when pH <7.15
36
Q

IV sodium bicarbonate dosing?

A

(0.5 L/kg x IBW) x (desired bicarb- actual bicarb)
administer 1/2 dose stat push, then give the rest over 4-6 hours

37
Q

when to give oral bicarb?

A

in mild case of metabolic acidosis where pH is 7.2-7.4

38
Q

signs of respiratory alkalosis

A

pH > 7.45
CO2 < 35
respiratory rate increased (from blowing off CO2)
can happen from altitude, setting mechanical ventilation too fast, hyperventilation.

39
Q

how to treat respiratory alkalosis

A

mechanical ventilation, “re-breathing” (brown paper bag), sedatives

prevention of altitude sickness with acetazolamide 1-2 days before ascent and continuing 2 days after arrival at altitude.

40
Q

signs of metabolic alkalosis

A

pH > 7.45
HCO3 > 26

41
Q

2 different etiologies of metabolic alkalosis

A

Chloride responsive (Cl urine < 15)

Chloride resistant (Cl urine > 25)

42
Q

what to do if chloride responsive metabolic alkalosis?

A

calc chloride deficit
(0.2 L/kg x kg) x (103- actual Cl)
replace chloride deficit with normal saline: Chloride deficit (mEq)/ 154 mEq/L

43
Q

what to do if chloride resistant metabolic alkalosis?

A

decrease/change corticosteroids
+/- spironolactone 100-400 mg/day in 1-2 divided doses
replete magnesium then potassium
acetazolamide 500 mg IV/PO daily

advanced nephrology (7 decks)

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