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Pulmonary Exam 1 > Acid/Base > Flashcards

Acid/Base Flashcards

1
Q

Acidosis

A

Metabolic: decrease HCO3 or =45 mmHg

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2
Q

Alkalosis

A

Metabolic: increase HCO3 > or = 28 mEq/L
Respiratory: decrease pCO2

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3
Q

Lungs

A
  • regulate ACUTE changes (occurs w/in seconds)

- regulates PCO2 through respiration rate and depth changes

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4
Q

Renal

A
  • regulates CHRONIC changes (takes hours- days to compensate)
  • regulates HCO3 and H through excretion/reabsorption/buffer
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5
Q

Primary METABOLIC disorder–> Respiratory compensation

A

meta acidosis –> compensate w/respiratory alkalosis

meta alkalosis–> compensate w/respiratory acidosis

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6
Q

Primary RESPIRATORY disorder–> Metabolic compensation

A

resp acidosis–> compensate w/metabolic alkalosis

resp alkalosis–> compensate w/metabolic acidosis

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7
Q

Acidosis Clinical Manifestation

A
  • hyperventilation
  • CNS depression
  • Hypotension
  • Hyperkalemia
  • Arrhythmias
  • decrease contractility
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8
Q

Alkalosis Clinical Manifestation

A
  • nerve excitation
  • Arrhythmias
  • respiratory depression
  • hypoventilation
  • hypokalemia
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9
Q

Step 1.

A

evaluate the pH

  • pH acidemia
  • pH > 7.40–> alkalemia
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10
Q

Step 2.

A

Is the primary disorder respiratory or metabolic?

–> it is problem with the HCO3 or the PCO2?

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11
Q

Step 3.

A

Calculate the anion gap.

AG= Na- Cl- HCO3

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12
Q

Step 4.

A

Check for compensation

  • winter’s formula for METABOLIC acidosis
  • -> pCO2= 1.5 (HCO3)+8 (+-2)
  • expected increase in pCO2 w/METABOLIC alkalosis
  • -> pCO2= 0.75 (pt’s HCP3- norm HCO3) (-+2)
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13
Q

Step 5.

A

If AGMA, check corrected HCO3

  • -> corrected HCO3= pt’s HCO3 + (pt’s AG- norm AG)
  • **norm AG= 12
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14
Q

Corrected HCO3

A
  • relationship between the serum HCO3 & AG
  • Indicates if degree of compensation is appropriate or if another metabolic acid/base disorder is present
  • for rise in AG by 1–> corresponding decrease of HCO by 1 mEq/L
  • if calculated HCO3 is not in the reference range (22-28 mEq/L)–> coexisting metabolic disturbance
  • —> if > norm, metabolic alkalosis
  • —> if
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15
Q

Causes of NAGMA

A

H: Hyperalimentation (high Cl soln) TPN & NS
A: Acetazolamide (inhibit Na reabsorption)
R: Renal tubular acidosis (proximal, distal, & hyperaldosteronism type 4)
D: Diarrhea
U: Uretero-pelvic shunt (fistula)- excessive loss of HCO3 from surgery or cancer
P: Post-hypocapnia (decreased CO2)
S: Spironolactone

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16
Q

Causes of AGMA

A 
M: Methanol/Metformin
U: Uremia (high BUN)--> CKD or AKI
D: Diabetic acidosis (DKA), ketoacidosis
P: Poisoning/ propylene glycol/ paraldehyde 
I: Intoxication/ infection/ isoniazid (INH)
L: Lactic acidosis (shock)
E: Ethylene glycol (antifreeze)
S: Salicylates/Sepsis
17
Q

Winter’s Formula

A

expected pCO2= 1.5 (HCO3) +8 (+-2)

- pCO2 predicted: coexisting respiratory acidosis

18
Q

Osmolar Gap

A
  • if you can’t easily identify a cause for an AGMA, calculated the osmolar gap.
  • osmolar gap= measured Osm- calculated Osm
  • calculated Osm= 2(Na) + BUN/2.8 + glucose/18 + EtOH/4.6
  • -> norm gap Osm gap > 10
19
Q

Typical Treatment for Metabolic acidosis

A
  • if pH is 7.20-7.35: focus on cause

- if pH

20
Q

Treatment Options for Metabolic acidosis- Sodium Bicarbonate

A

***Goal: target pH 7.2
tab: 3.9 mEq/ 325 mg, chronic replacement in renal failure or renal tubular acidosis
IV: 50 mEq or mmol ampule; isotonic soln in D5W or SW 150 mEq NaHCO3/ 1 L, reserve for acute situations no evidence-based benefit

21
Q

Treatment Options for Metabolic acidosis- Sodium citrate/ citric acid

A

Alkali: 1 mEq/ mL soln

- chronic replacement in renal failure or renal tubular acidosis

22
Q

Treatment Options for Metabolic acidosis- Tromethamine (THAM)

A

Alkali: sodium-free buffer

  • reserve for acute situations
  • no benefit over sodium bicarbonate
23
Q

Treatment Options for Metabolic acidosis- Hemodialysis

A 
A:
E:
I:
O:
U: 
- reserved for acute situations
24
Q

Metabolic Alkalosis Causes

A 
C: contraction
L: Licorice
E: Endocrine (Conn's, Cushing's, Bartter's syn)
V: vomiting
E: excess alkali (Sodium bicarb)
R: refeeding alkalosis (malnurished pt's)
P: post-hypercapnia
D: diuretics
25
Q

Compensation for metabolic alkalosis

A

exp increase in pCO2= 0.75 (pt’s HCO3- norm HCO3 {12})

- if pCO2 predicted: respiratory acidosis

26
Q

Treatment for metabolic alkalosis: volume-dependent or saline-responsive

A
  1. vomiting
  2. nasogastric suction
  3. diuretics
    Urine Chloride:
27
Q

Treatment for metabolic alkalosis: volume-independent or saline-resistant

A
  1. mineralcorticoid excess
    –> Cushing’s syn
    –> Conn’s syn
  2. hypokalemia
    Urine Chloride: > 20 mEq/L
    Treat:
    - treat underlying disorder
    - potassium replacement
28
Q

Respiratory Acidosis causes

A

C: CNS depression (stroke, opiate OD, seizures, sedation, head trauma)
A: Airway obstruction (COPD)
N: Neuromuscular disorders (ALS, Guillain Barre, Myasthenia gravis)
S: Severe pneumonia, pulmonary embolism, pulmonary edema

29
Q

Compensation for Respiratory Acidosis

A
  • for each 10 mmHg increase in pCO2, pH will decrease by:
  • -> 0.08 units in ACUTE respiratory acidosis
  • -> 0.03 units in CHRONIC respiratory acidosis
30
Q

Treatment for Respiratory Acidosis

A
  • Focus on cause
  • Oxygen therapy
  • ***NEVER use added base for respiratory acidosis
31
Q

Respiratory Alkalosis cause

A

C: CNS stimulation (pain, anxiety, fever, tumors, stroke, head trauma)
H: hypoxia
A: anxiety
M: mechanical ventilation
P: progesterone (pregnancy & cirrhosis)
S: salicylates/sepsis

32
Q

Compensation for Respiratory Alkalosis

A
  • for each 10 mmHg decrease in pCO2, pH will increase by
  • -> 0.08 units in ACUTE respiratory alkalosis
  • -> 0.03 units in CHRONIC respiratory alkalosis
33
Q

Treatment for Respiratory Alkalosis

A
  • focus on cause
  • hypoventilation
  • breathe into a bag for anxiety
  • sedation
34
Q

General Treatment Principles

A
  • ALWAYS correct underlying etiology
  • ->DKA: stop ketoacid production, correct volume depletion, and normalize blood glucose
  • ->Uremia: renal replacement therapy (dialysis)
  • -> excessive vomiting: antiemetics
  • -> COPD exacerbation: oxygen, bronchodilators, corticosteroids, possibly antibiotics
  • -> narcotic OD: opiod antagonist
  • Alkali or acid replacement
  • -> reserved for critically-ill pt’s
  • -> only provides a “temporary fix”

Pulmonary Exam 1 (4 decks)

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