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NU 737 > Acid Base Balance > Flashcards

Acid Base Balance Flashcards

1
Q

Normal Acid Base
Organs?
Leveles ?

A
  • Cooperation of Lungs and Kidneys + GI
  • **GI: **Acid-Base Disturbances; Backdrop for acid base disorders
  • Normal Range of pH 7.35 to 7.45
  • Tight Conrol Need
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2
Q

Disturbances Repitory

A

CO2
Only one respitory disturbance possible

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3
Q

Disturbance HCO3 (Bicarb)

A

GI /Metabolic Disturbance
More than one metabolic Disturbance co-exist
Coexisting metabolic acidosis and alkalosis (vomiting)

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4
Q

Homeostasis
Dependent on compensation

A

Compendsation for RR distrurbance =>metabolic
Compensation for metabolic disturbance =>Respitory

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5
Q

Metabolic Acidosis
Can lead to what

A

Acidemia

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6
Q

Acidemia

A

-Result in Metabolic Acidosis
- High Hyrogen Ion concentration Or Low PH of Blood (<7.35)
- Reduction occurs due to reduction of Extracellular Bicarbonates
- Reduced by consumption of bicarb or primary loss
-

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7
Q

Amoniagenesis
Aciddemia
Alkalosis

A

Stimulated by Acidemia
Inhibted by Alkalosis

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8
Q

Ammoniagenesis
Hyperkalemia and Hypokalemia

A

Inhibit - Hyperkalemia
Stimulate -Hypokalemia

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9
Q

Metablic Acidosis
Causes

A
  • Excessive Production of Fixed Acid
  • Decreased renal Secretion Fixed Acid
    *** Loss of Bicarbonate (CO 3) **
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10
Q

Plasma Anion Gap

A

Normal Level : (8)
Formula: Na-(CO3+CL)
Difference of cation vs anions
Albumin : Always Proportional to Anion Gap

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11
Q

Hypoalbuminemia W Anion Gap

A

Albumin always proportion Anion Gap
Falsely **Lower **Anion Gap –>

                          ****Hihgh Anion Gap Acidosis **
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12
Q

Increase Albumin

A

Increase Anion Gap
Fallse impressio of High anion Gap Acidosis

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13
Q

Metabolic Acidosis
**High Anion Gap Acidosis (open GaP )

A

Lactic Acidosis : Most common Reason
* Propylene Glycol
Ketoacidois
ETOH
Starvation , Intoxications, Salicylate

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14
Q

Propylene Glycol ?

A

Reason for High GAP metablolic Acidosis

Solven found in Common medications result in

Ativen
Nitroglycerin
Etomidate
Phenytoin

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15
Q

What Are the reason for Lacic Acidosis
W High GAP

A
  • Not Always Sepsis
  • Type A and Type B
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16
Q

Cause of Lactic Acidosis
Type A

A
  • Imbalance of tissue O2 demand and supply
  • Decrease O2 delivery
  • Shock, HYpoxia, Profound Anemia, Carbon Monoxide Poison
  • Gran mal seizure or exreme exercise
17
Q

Lactic Acidosis
Type B Cause

A

Encapsulates other etiology
HIV, ETHO, Malignancy
Liver failure

18
Q

Metabolic Acidosis
**Non-Gapped : Causes **

A
  • **Renal Tubular Acidosis **
    Post-Hypocapnic Metabolic Acidosis
    Dilutional Hyperchloremic Acidosis
19
Q

What is
Renal Tubular Acidosis

A
  • HCO3 Falls &
  • CL Increased
  • Gap Not open
    = Non-Gap Metabolic Acidosis
20
Q

Dilutional Hyperchloremic Acidosis

A

Resucitation w Isotonic Saline
Blood HCO3 -diluted

21
Q

Post-Hypocapnic Metabolic Acidosis

A

HCO3 falls
in compensation for
Chronic RR alkalosis
Unchange GAp

22
Q

Metabolic Acidosis
Severe Acidemia
PH?

A

PH < 7.20
Cardiovasular function
Hepatic Function
Metabolic derangements

23
Q

**HCO3 LOW (below 22)
Increase Anion Gap **
**What DX? **

A

High Anion Gap metabolic Acidosis
occurs

24
Q

Low CO3 (<22)
None Gap

A
  • Hypercholoremic metabolic acidosis
  • Respitory alkalosis w metabolic compensation
  • Lactic Acidosis (Check LA ) –> DKA, Starvation, ETOH
25
Q

Metabolic Acidosis
Treatment Plan

A
  • PH <7.10
  • Treat underlying cause
  • Treat RR etiology first
  • Sodium Bicarb (Alkali solution ) with Goal 7.20
  • HD/CRRT : metoformin induced acidosis
26
Q

Metabolic Alkalosis
Overview

A

Accumulation of Bicarb
PH increase (PH > 7.45)
Due to
Hypoventilation
CO2 Retension

27
Q

Metabolic Alkalosis
Two Causes ?

A

1**. Genrate Alkalosis **
A. Loss of Acid from body
B. Renal source
2. Maintain or Perpetuate Alkalois
Volume Depletion
Hypokalemia

28
Q

Generating Alkalosis
**Loss of Acid from Body **

A

GI source
Vomiting
Gastric Suction

29
Q

Generating Alkalosis
Renal Source

A

High NA delivery
Corticoid
K depletion
High Renal Ammoniagenesis

30
Q

Metabolic Alkalosis
Maintaining Alkalosis

A

Relative or
Absolute

31
Q

Relative Metabolic Alkalosis

A
  • **Volume Depletion **
  • RElative
  • Diminished effective circulatting Volume
  • reduce GFR
  • Enhance CO3
    Secondary to Hyperaldosteronis

Overload secondary to Volume Overload

32
Q

Bohr Effect

A

**Increase Hgb O2 affinity **
Impaired O2 delivery to tissues

32
Q
  • lactic Alkalosis
A

Low PCO2
Elevated Blood lactate level

33
Q

Perpetuating factors for
Alkalosis

A

Hypokalemia
Gastric losss
Supress Ventilation

NU 737 (8 decks)

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