acid base 2 Flashcards
what results from HCO3- losses in the ECF, being replaced by Cl-
metabolic acidosis
what are 3 drugs administered that often result in metabolic acidosis
- acetazolamide
- calcium chloride
- excessive NACL administration
what will arterial blood cases look like in metabolic acidosis
- decreased pH
- decreased pCO2
- decreased bicarbonate
what is the goal of treatment in non anion gap MA
maintain pH greater than 7.2 and cerum CO2 greater than 10-12
what is the danger of excessive bicarb therapy in NAGMA
decrease myocardial contractility, fluid overload, and hypernatremia
metabolic alkalosis can result from what
- net loss of H+ from ECF
- net addition of bicarbonate or precursors
- loss of Cl- rich, bicarbonate poor fluid
what are two classifications of metabolic alkalosis
chloride responsice metabolic alkalosis
chloride resistant metabolic alkalosis
diuretic therapy often causes what
NACL responsive metabolic alkalosis
what are the signs and symptoms of severe alkalemia
- cardiovascular - arrhythmias, or myocardial depression
- neuromuscular
- CNS - cerebral vasoconstriction, seizures, and coma
what is the respiratory response to metabolic alkalosis
hypoventilation to help retain pCO2
if a patient can’t tolerate volume increase, what is used to treat nacl responsive metabolic alkalosis
acetazolamide
what is the goal of treatment for nacl resistant metabolic alkalosis
reduction of mineralocorticoid activity
what are 4 common treatments for nacl resistant metabolic alkalosis
- methylprednisolone
- spironolactone
- amiloride
- triamterene
how do spironolactone, amiloride or triamterene treat nacl resistant metabolic alkalosis
inhibit aldosterone mediated sodium reabsorption
describe respiratory acidosis
lungs retain too much carbon dioxide secondary to poor ventilation or poor perfusion
describe acute respiratory acidosis
not much time for HCO3- retention to increase causing dramatic ph reduction
describe chronic respiratory acidosis
more time for hco3- retention causing a lessened pH reduction due to greater compensation
what are the 3 main etiologies of respiratory acidosis
- impaired CNS respiratory drive (stroke, brain injury, seizures, drugs)
- impaired gas exchange in the lungs (COPD)
- impaired neuromuscular function in the diaphragm or chest wall (measthenia gravis)
