acid base 2

Question 1

what results from HCO3- losses in the ECF, being replaced by Cl-

Answer 1

metabolic acidosis

Question 2

what are 3 drugs administered that often result in metabolic acidosis

Answer 2

1. acetazolamide
2. calcium chloride
3. excessive NACL administration

Question 3

what will arterial blood cases look like in metabolic acidosis

Answer 3

1. decreased pH
2. decreased pCO2
3. decreased bicarbonate

Question 4

what is the goal of treatment in non anion gap MA

Answer 4

maintain pH greater than 7.2 and cerum CO2 greater than 10-12

Question 5

what is the danger of excessive bicarb therapy in NAGMA

Answer 5

decrease myocardial contractility, fluid overload, and hypernatremia

Question 6

metabolic alkalosis can result from what

Answer 6

1. net loss of H+ from ECF
2. net addition of bicarbonate or precursors
3. loss of Cl- rich, bicarbonate poor fluid

Question 7

what are two classifications of metabolic alkalosis

Answer 7

chloride responsice metabolic alkalosis

chloride resistant metabolic alkalosis

Question 8

diuretic therapy often causes what

Answer 8

NACL responsive metabolic alkalosis

Question 9

what are the signs and symptoms of severe alkalemia

Answer 9

1. cardiovascular - arrhythmias, or myocardial depression
2. neuromuscular
3. CNS - cerebral vasoconstriction, seizures, and coma

Question 10

what is the respiratory response to metabolic alkalosis

Answer 10

hypoventilation to help retain pCO2

Question 11

if a patient can’t tolerate volume increase, what is used to treat nacl responsive metabolic alkalosis

Answer 11

acetazolamide

Question 12

what is the goal of treatment for nacl resistant metabolic alkalosis

Answer 12

reduction of mineralocorticoid activity

Question 13

what are 4 common treatments for nacl resistant metabolic alkalosis

Answer 13

1. methylprednisolone
2. spironolactone
3. amiloride
4. triamterene

Question 14

how do spironolactone, amiloride or triamterene treat nacl resistant metabolic alkalosis

Answer 14

inhibit aldosterone mediated sodium reabsorption

Question 15

describe respiratory acidosis

Answer 15

lungs retain too much carbon dioxide secondary to poor ventilation or poor perfusion

Question 16

describe acute respiratory acidosis

Answer 16

not much time for HCO3- retention to increase causing dramatic ph reduction

Question 17

describe chronic respiratory acidosis

Answer 17

more time for hco3- retention causing a lessened pH reduction due to greater compensation

Question 18

what are the 3 main etiologies of respiratory acidosis

Answer 18

1. impaired CNS respiratory drive (stroke, brain injury, seizures, drugs)
2. impaired gas exchange in the lungs (COPD)
3. impaired neuromuscular function in the diaphragm or chest wall (measthenia gravis)