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Respiratory > Acid Base 2 > Flashcards

Acid Base 2 Flashcards

1
Q

What is the presentation of acute metabolic acidosis?

A

pH < 7.2
Hyperventilation
Bradycardia/HF
Obtundation/confusion

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2
Q

What acidic pH is incompatible with life?

A

6.7

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3
Q

What is the presentation of chronic metabolic acidosis?

A

pH 7.2 - 7.34

Relatively asx

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4
Q

What are causes of chronic metabolic acidosis?

A

Renal tubular acidosis

Chronic renal insufficiency

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5
Q

What are the causes of bone demineralization?

A 
Children = Rickets (growth failure, weight loss)
Adults = Osteopenia (RTA, CRI)
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6
Q

What does a metabolic acidosis with a normal anion gap represent?

A

Decreased HCO3
Increased Cl
Keeps electroneutrality

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7
Q

What is a cause of metabolic acidosis with a normal anion gap?

A

Excessive diarrhea

Intrinsic Renal Disease (RTA)

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8
Q

What is a clinically relevant anion gap?

A

greater than 17

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9
Q

How does excessive diarrhea cause hyperchloremic metabolic acidosis?

A

Pancreatic secretions are rich in bicarbonate
Excessive loss of bicarb results in excessive reabsorption of H+
Cl reabsorbed (as part of this exchange) = minimizes gap

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10
Q

How does intrinsic renal disease cause hyperchloremic metabolic acidosis?

A

Normally, H+ ions are almost entirely eliminated by kidneys
RTA = inability to eliminate H+
Prevents reabsorption of bicarb, and Cl is retained

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11
Q

What is another name for a metabolic acidosis with a normal anion gap?

A

Hyperchloremic metabolic acidosis

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12
Q

What causes an increased anion gap in metabolic acidosis?

A

Presence of organic acids (lactic acids, ketoacids, and uremic acids) or toxins
Acids/toxins consume bicarb becoming anions
See a decreased bicarb with increased chlorine

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13
Q

What does MUDPILES stand for?

A 
Methanol
Uremia
DKA
Propylene glycol
Isoniazid
Lactic acid
Ethanol
Salicylates
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14
Q

What are the sources that increase the anion gap?

A

DKA
Uremia
Ethanol
Lactic acidosis

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15
Q

What is the treatment strategy for severe metabolic acidosis?

A

pH < 7.2
Goal pH = 7.2
Goal HCO3 = 10-12
Give IV sodium bicarb

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16
Q

What is the dose of bicarb in a vial?

A

50meq/50mL

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17
Q

How do we calculate the sodium bicarbonate dosage?

A

(0.5L/kg x wt) x (Goal bicarb - current bicarb)

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18
Q

What is the target serum bicarb for severe metabolic acidosis?

A

10-12 in 24 hours

Administer 50% over 4 hours, then last 50% over next 20 hours

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19
Q

What is the target serum bicarb for moderate metabolic acidosis?

A

22-24 over 3-5 days

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20
Q

What are problems with administered bicarb IV?

A

Systemic overshoot (excessive dosing in DKA, lactic acidosis, ARF, ?Ethanol)
Severe hypernatremia
Extravasation

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21
Q

What is a problem with administering oral bicarb

A

GI intolerance

22
Q

What is the treatment strategy for moderate metabolic acidosis?

A

pH 7.2 - 7.34
Goal pH = 7.4
Goal bicarb = 22-26
Give oral bicarb

23
Q

What is severe alkalosis?

A

pH > 7.6

24
Q

What pH is incompatible with life?

A

> 7.7

25
Q

What os the presentation of metabolic alkalosis?

A

Hypovolemia
Hypervolemia
pH > 7.6

26
Q

What are the affects of a pH > 7.6?

A 
Cardiac arrhythmias
NM irritability (tetany/tremors)
27
Q

What are the causes of metabolic alkalosis?

A

Increased bicarb retention
Increased bicarb concentration
Hyperaldosteronism

28
Q

What causes bicarb retention?

A

Loss of H+ ions
Nasogastric suctioning
Vomiting

29
Q

What causes increased bicarb concentrations?

A

Diuretics from contraction alkalosis

30
Q

What diseases cause hyperaldosteronism?

A

Cushing’s

Hyperaldosteronism

31
Q

How does hyperaldosteronism cause metabolic acidosis

A

Promote hyper renin states

32
Q

If a patient has metabolic alkalosis and is hypovolemic, how do we treat them?

A

IV NaCl

33
Q

If a patient has metabolic acidosis and is euvolemic, how do we treat them?

A

Aldosterone antagonist

34
Q

If a patient has a pH greater than 7.6, how do we treat them?

A

Hydrochloric acid

35
Q

What is the presentation of respiratory alkalosis?

A

Hyperventilation
CNS (agitation/anxiety, lightheadedness)
CV (chest pain)

36
Q

What are the results of hyperventilation?

A

Decreased CO2
Lightheadedness, confusion, syncope
N/V
Muscle cramps, tetany

37
Q

What are the causes of hyperventilation?

A

CNS mediated
Medications
Others

38
Q

What CNS causes are associated with hyperventilation?

A 
Pain
Anxiety
Fever
Head trauma
CVA
39
Q

What medications are associated with hyperventilation?

A

Theophylline
Nicotine
Catecholamines

40
Q

What are other causes of hyperventilation?

A

Severe anemia
High altitude
Hyperthyroidism

41
Q

What is the treatment strategy if the patient has respiratory alkalosis and their pH is < 7.6?

A

Remove underlying cause

42
Q

When do we give O2 in respiratory alkalosis?

A

PaO2 < 50

43
Q

What is the treatment for respiratory alkalosis with a pH > 7.6?

A

Mechanical ventilation

44
Q

What is severe acidosis?

A

pH < 7.2

45
Q

What acidosis is incompatible with life?

A

< 6.7

46
Q

What is the cause of respiratory acidosis?

A 
Failure of lungs to eliminate CO2
Ventilatory failure (Obstructive lung dz/NM dz)
Perfusion failure (Massive PE)
47
Q

What is the presentation of respiratory acidosis?

A

Compatible with life despite paCO2 80-100
No longer dependent on Co2 for respiratory drive
Dependent on O2 for respiratory drive

48
Q

What patients are highly susceptible to acute respiratory decompensation?

A

Acute respiratory infections
Narctoic analgesics
Sedative/hypnotics
O2 (CO2 narcosis)

49
Q

When do we give mechanical ventilation?

A

Acute respiratory acidosis
PaCO2 > 80
or
PaO2 < 40

50
Q

When do we give O2 in respiratory acidosis?

A

Chronic respiratory acidosis

PaO2 < 50

Respiratory (8 decks)

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