Acid Base Flashcards
Base
Accept H ions
Carbohydrate metabolism
(CO2) carried in plasma as carbonic acid
CO2 in plasma..
Becomes bound with water making it carbonic acid.
-binding of water is how it gets its H ion
Metabolism of fats
Ketoacids
Metabolism of proteins
Sulfuric acid
Tissue hypoxia
Lactic acid
-anabolic process
Cell destruction
Ex.chemotherapy
- acids get released from inside of cells into the plasma
Fixed acids
Ketoacids
Sulfuric acids
Lactic acids
Cell destruction
-excreted through the kidneys
Bicarbonate
- weak base
- most abundant base in body
- get lots of bicarbonate through amino acids
Ammonia
- strong base
- largely made in kidneys
Normal pH
7.35-7.45
Fatal pH range
Below 6.9 or above 7.8
Carbonic acid to bicarbonate ratio
1 part carbonic acid per 20 parts bicarbonate
Four reasons of acidosis
- over production of H ion
- insufficient elimination of H ion
- under production of alkali
- over excretion of alkali
Key S/S of acidosis
-depressed CNS
-skeletal muscle weakness
-kussmaul respiration during metabolic acidosis
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4 reasons of alkalosis
- over production of base
- insufficient elimination of base
- underproduction of acid
- excessive elimination of acid
Key S/S of alkalosis
- anxiety,irritability
- increased CNS activity
- increased HR
- low BP
Buffer systems
1 rapid acting system
- take care of most mild imbalances
- reduce or increase H ions in plasma
Bicarbonate buffer system
Carbonic acid system
Phosphate buffer system
Most active in renal tubules
Protein buffer system
Hemoglobin has ability to absorb H ions
Most common buffers
Respiratory system
- controlled by the medulla
- works by only controlling CO2
- second line of defense after buffer I g systems
- can only correct imbalances for a number of hours
Kidney regulation
- most powerful regulator
- can take days to regulate
- increase excretion or reabsorption of acids and bases
Respiratory acidosis
- results in retention of CO2
- the kidney will excrete more H ions and hold bicarbonate
Clinical manifestations of respiratory acidosis
- COPD
- pneumonia
- asthma
- bronchitis
- certain meds
- broken ribs
- obesity
S/S of acute respiratory acidosis
- altered LOC
- flushed warm skin(CO2) is a vasodilator
- headache
- reduced muscle tone
- ineffective respirations(source of problem
Potassium shuffle with acidosis(how body fixes it)
Potassium moves from inside of the cell to allow H+ ion to enter the cell
Result in plasma will be more potassium, less acidity, and higher pH
Treatment for respiratory alkalosis
- drug therapy: bronchodilators,anti inflammatories, mucolytics
- oxygen
- positioning
- suction
- mechanical effort
-asses breathing effort and lung sounds
Respiratory alkalosis
-caused by hyperventilation, leads to a decrease in CO2
Clinical situation of respiratory alkalosis
- fever
- pain
- CVA
- high altitude
What will kidneys do to help respiratory alkalosis
Respond by increase excretion of bicarbonate and increase retention of H+ ions
Potassium shuffle with alkalosis
Plasma potassium moves from the plasma into the cell to allow H+ ion to enter the plasma
- result in plasma will be less potassium, more acidity, and lower pH
S/S of respiratory alkalosis
- tachypnea
- dizziness
- muscle weakness
- syncope
-parenthesias, seizures, and hypereflexia due to hypocalcemia caused by increased pH
Treatment of respiratory alkalosis
- relieve anxiety
- breath more slowly
- partial rebreather mask
- seizure precautions
- reduce fever
Metabolic acidosis
-too many fixed acids lead to lower pH
- diabetes poster child
- anorexia, bulimia, poor diet: not taking in adequate energy sources and body breaks down fats and proteins releasing acids
- renal failure
Metabolic acidosis by lose of bases leadin to over abundance of acids
- diarrhea
- malabsorption disorders
- pancreatic disorders
How will the lungs try to help metabolic acidosis
Kussmaul’s respirations: deep rapid respirations
What can kidneys due to aid in metabolic acidosis
Excrete H+ buffered with ammonia in the urine, retain bicarbonate
S/S of metabolic acidosis
- decreased CNS
- muscle weakness
- hyperkalemia(more K in plasma)
- Kussmaul’s respirations
Normal anion gap
8-14
-larger than 14 is an accumulation of acids
Treatment of metabolic acidosis
- for diabetes give insulin(stops production of keytone acids)
- GI loss: antidarrheals
- give bicarbonate as ordered
- renal failure: dialysis
Metabolic alkalosis
Excessive intake or loss of acids: leads to an over abundance of base
Hydrochloric acid loss: NG tube/ vomiting
-loss of chloride leads to increase in bicarbonate retention in kidneys( making the situation worse)
Metabolic alkalosis and diuretics
Hypocalcemia often occurs due to diuretics
-this loss of potassium leads to increased H+ excretion from kidneys and results in alkalosis
S/S of alkalosis
Confusion
Anxiety
Irritability
-paresthesias, seizure, hyperreflexia due to hypocalcemia caused by increased pH
Treatment of metabolic alkalosis
- decrease/ chance diuretics
- acetazalomide Diamox(diuretic) to increase renal excretion of bicarbonate
- decrease suctioning
- control vomiting
- provide chloride, potassium in IV
Acids
Give away H ions
