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Coexisting Disease/Comprehensive Exam - PPT Questions > Acid-Base Balance > Flashcards

Acid-Base Balance Flashcards

1
Q

The terms acidosis and alklaosis refer to acid-base derangments that produce either excess ___ or excess ____, respectively that may be present regardless of pH.

A

H+ (hydrogen); OH- (hydroxide)

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2
Q

The relationship of CO/HCO3 buffer system to pH is expressed by teh _____ equtaion.

A

Henderson-Hasselbalch

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3
Q

What is the Henderson-Hasselbalch equation?

A

pH = 6.1 + log (serum bicarb concentration/0.03 x PaCO2)

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4
Q

____ - chemical species that can act as a proton (H+) donor

A

acid

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5
Q

_____ - chemical speciies that can act as a proton (H+) acceptor

A

Base

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6
Q

What does pH stand for?

A

potential of hydrogen

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7
Q

With increased pH, the hydrogen ion increases or decresaes?

A

decreases

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8
Q

With decreased pH, the hydrogen ion increases or decreases?

A

increases

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9
Q

What does the Henderson-Hasselbach equation describe?

A

The relationship between plasma pH and the ration of plasma PCO2 and HCO3

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10
Q

What is the immediate buffer system?

A

carbonic acid-bicarbonate system

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11
Q

What is the primary ECF buffer system?

A

Carbonic acid bicarbonate buffer system

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12
Q

The carbonic acid-bicarbonate buffer system maintains a ratio of ____ bicarbonate to ____ carbonic acid.

A

20 parts; 1 part

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13
Q

What uses the process of hydration of CO2 to break it down so it can be neutralized?

A

Carbonic acid-bicarbonate buffer system

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14
Q

The respiatroy buffer system acts within ____ to ____.

A

minutes to 12-24 hours

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15
Q

How does the respiratory buffer system work?

A

H2CO3 is converted to CO2 and excreted by lungs

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16
Q

Alveolar ventilation increases as pH _____.

A

decreases

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17
Q

How does renal buffer system work?

A

Regulates amount of bicarbonate absorbed or excreted; regulates ammonia and electrolytes

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18
Q

Renal regulation of buffer system: Within the renal tubule CO2 combines with _____ in the presence of carbonic anhydrase to form H2CO3 which readily disassociates into ___ and ___. The proximal tubules normal reabsorb 80-90% of this filtered ______.

A

H2O; H+ and HCO3; HCO3

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19
Q

What GI issues cause metabolic alkalosis?

A

vomiting, NG drainage, chloride wasting diarrhea

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20
Q

What urinary issues cause metabolic alkalosis?

A

diuretic administration, hyperaldosteronism

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21
Q

What are some examples of excessive HCO3 loads that can cuase metabolic alkalosis?

A
  • NaHCO3 admin
  • Lactate, acetate, citrate admin
  • Alkali admin to patients w/ renal failure
  • abrupt correction of chronic hypercapnia
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22
Q

Metabolic alkaloses can be characterized as ___ responsive or resistant.

A

chloride

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23
Q

How is volume-depletion metabolic alkalosis treated?

A

Chloride replacement along wtih fluid resuscitation using saline

24
Q

Salien is a weak acid or base?

A

acide

25
Q

If metabolic alkalosis has been caused by gastric losses of hydrohloric acid, _____ can be given to stop perpetuation of the alklaosis.

A

PPI

26
Q

Metabolic alkalosis associated with loop diuretics can be improved by adding or substituting ______ diuretics.

A

postassium-sparing

27
Q

What fluid is preferable in metabolic alkalosis treatment?

A

NS

28
Q

What happens to serum potassium with metabolic alkalosis?

A

decreases

29
Q

What happens to iCa with metabolic alklosis?

A

decreases

30
Q

A ___ shift in the oxyhemoglobin dissociation curve occurs with metabolic alkalosis.

A

leftward

31
Q

HCO3 decreases by ___ for each ___ mmHg decrease in PaCO2 below 40.

A

2-5; 10

32
Q

What are causes of respiratory alklaosis? (6)

A
  • iatrogenic (hyperventilation)
  • high altitude
  • CNS injury
  • hepatic disease
  • pregnancy
  • ASA OD
33
Q

____ OD is associated with respiratory alklosis?

A

Salicylate (ASA)

34
Q

The ____ and ___ that may co-exist with respiratory alklosis may also require treatment.

A

hypokalemia and hypochloremia

35
Q

T/F: Seizures, bradycardia, hyperkalemia, and lethargy and confusion are associated with respiratory alkalosis.

A

false - seizures, tachycardia, hypokalemia, & lethargy and confusion

36
Q

What are 8 causes of respiratory acidosis?

A
  1. drug-induced ventilatory depression
  2. permissive hypercapnia
  3. UA obstruction
  4. status asthmaticus
  5. restriction of ventilation
  6. disorders of NM function
  7. MH
  8. hyperalimentation
37
Q

What acid base condition occurs with status asthmatiuc?

A

respiratory acidosis

38
Q

What patient population do you want to be careful when correcting respiratory acidosis?

A

COPD/those used to chronic incrased PaCO2 … rapid lowering of PaCO2 in these patients decreases body stores of CO2 more rapidly than the kidneys can produce corresponding decrease in HCO3 (this metabolic alklaosis –> seizures, etc.)

39
Q

Hyperkalemia or hypokalemia occurs with respiratory acidosis?

A

hyperkalemia

40
Q

Metabolic acidosis with signficant reduction of pH can cause what 4 physiologic effects?

A
  1. increased PVR
  2. reduced myocardial contractiliy
  3. decreased SVR
  4. impaired response of CV system to catecholamines
41
Q

Metabolic acidosis is divided into what 2 groups?

A

normal anion gap and high anion gap

42
Q

When does a high anion gap occur?

A

When a fixed acid is added to the extracellular space, the acid dissociates, the H+ ion combines with bicarbonate form in carbonic acid, and the decreased bicarbonate concentration produced an increased anion gap

43
Q

What are some examples of high anion gap metabolic acidosis?

A

Lactic acidosis, DKA, renal failure, poisonings

44
Q

Non-anion gap metabolic acidosis is the result of __________.

A

a net increase in Cl concentration

45
Q

A normal anion gap acidosis is also known as?

A

hyperchloremic metabolic acidosis

46
Q

What are the most common causes of a normal-anion gap acidosis?

A

IV infusion of NS and GI and renal losses of bicarb (diarrhea, renal tubular acidosis, early renal faiure)

47
Q

What type of respiration occurs with metabolic acidosis?

A

Kussmaul

48
Q

What poisonings and intoxications are assoicated with metabolic acidosis?

A

intoxicaiton - methanol, ethylene glycol, ASA
poisoning - cyanide, carbon monoxide

49
Q

What acid-base disorder is associated with rhabdo?

A

metabolic acidosis

50
Q

What can cause lactic acidosis?

A

severe tissue hypoxia d/t hypoxemia, hypoperfusion, ischemia, or inability to use O2 (cyanide)

51
Q

Define base excess.

A

Amount of acid or base that must be added to return blood pH to 7.4 and PaCO2 to 40 at full O2 sat and 37C.

52
Q

A ____ value base excess indicates metabolic alkalosis.

A

positive

53
Q

A ____ value base excess indicates metabolic acidosis.

A

negative

54
Q

How is metabolic acidosis commonly treated?

A

sodium bicarbonate

55
Q

How does sodium bicarbonate work?

A

Bicarbonate combines with hydrogen ions and in the presence of the enzyme carbonic anhydrase becomes CO2 and H2O.

56
Q

Sodium bicarbonate is best reserved for patients with adequate ventilation and pH ____

A

<7.2

57
Q

What is the first treatment for lactic acidosis?

A

Fluids/volume resuscitation and oxygenation

Coexisting Disease/Comprehensive Exam - PPT Questions (6 decks)

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