Acid Base Balance Flashcards
Respiratory acidosis
PH < 7.35 with PCO2 >45
Respiratory acidosis signs and symptoms
- Myoclonus with asterixis
Somnolence and confusion, coma
Management of respiratory acidosis
Narcan for all patients with no obvious cause
Improve ventilation, intubate if necessary
Increase rate on ventilator
Respiratory alkalosis
Hyperventilation decreases arterial PCO2 and increases pH. Clinical symptoms are related to decreased cerebral blood flow
Signs and symptoms of respiratory alkalosis
- paresthesia, stocking/glove tingling
Lightheadedness, anxiety, tetany if very severe
Respiratory alkalisis lab and diagnostics
pH > 7.45
Low pCO2 < 35
Serum HCO3 low if chronic
Respiratory alkalosis management
Manage underlying cause, if acute hyperventilation syndrome is present, have the patient breathe into a paper bag. Decrease rate of ventilator as needed, sedation may be necessary, rapid correction of chronic alkalosis may result in metabolic acidosis
Metabolic acidosis
The hallmark sign is a low serum bicarbonate
Measurement of a young gap Lends some clues towards evaluating the cause considering treatments
Anion gap formula
[(Na+) + (K+)] - [(HCO3 + Cl-)]
Anion Gap
7-17
Increased anion gap causes
Diabetic keto acidosis, alcoholic ketoacidosis, lactic acidosis
Normal anion gap causes
Diarrhea, ileostomy, recovery from DKA
* renal tubular acidosis
Treatment of metabolic acidosis with increased gap
Treat underline disorder, fluid resuscitation
Metabolic alkalosis
Characterized by a high plasma bicarb and compensatory PCO2 rarely exceeds 55. If PCO2 is greater than 55 super imposed respiratory acidosis is likely
Metabolic alkalosis causes
Saline responsive ( volume contraction) most common Post hypercapnia alkalosis, NG suction , vomiting, diuretics
