Acid-Base Blitz

Question 1

Carbonic acid buffering system

Answer 1

•First line of defense
•Sec to sec system
•Operates in blood, lungs, and kidneys

Question 2

Respiratory buffering system

Answer 2

•2nd line of defense
•Min to Min

Question 3

Kidney buffering system

Answer 3

•3rd line of defense
•hours to days

Question 4

Normal pH range

Answer 4

7.35-7.45

Question 5

Normal PaCO2 range(ETCO2)

Answer 5

35-45mmHg

Question 6

Normal HCO3- range

Answer 6

22-26

Question 7

Normal PaO2 range

Answer 7

80-100

Question 8

Normal BE range(Base Excess)

Answer 8

-2/+2
• -2 means 2 extra acids
• +2 means 2 extra alkali(base)

Question 9

Example of Uncompensated pH
(First name)

Answer 9

Anything >/< 7.35-7.45
Ex: 7.22= uncompensated
Ex: 7.50= uncompensated

Question 10

Is the pH acidic or basic?
(Last name)

Answer 10

> 7.45 = Basic or Alkali(uncompensated)
< 7.35 = Acidic(uncompensated)
7.37 = Acidic(COMPENSATED)
**perfect pH is 7.4

Question 11

How to tell if the problem is respiratory or metabolic? (Middle name)

Answer 11

•Look at PaCO2 and HCO3-
•Increased CO2 with a low pH = respiratory acidosis
•Decreased HCO3- with a low pH = metabolic acidosis.
**pH and CO2 move opposite of each other

Question 12

How to identify a mixed disturbance

Answer 12

If PaCO2 and HCO3- are moving in the same direction, it’s mixed, not compensated.
•Ex: high PaCO2 = gained acid
low HCO3- = gained acid
•normal compensation means PaCO2 and HCO3- are moving opposite of each other

Question 13

Golden rules of ABGs

Answer 13

1- for q 10 point change in PaCO2, we have an opposite change in pH by 0.08

Question 14

Causes for Respiratory Acidosis

Answer 14

•Hypoventilation
•Airway obstruction
•Chest trauma/Neuromuscular disease
•Pulmonary Edema
•Drug OD

*increase in CO2 and decrease in pH

Question 15

Causes of Metabolic Acidosis

Answer 15

•Shock
•Sepsis
•Severe Diarrhea
•Renal failure
•Salicylate OD(ASA)

*Decrease in pH and HCO3-

Question 16

Metabolic Acidosis Identification

Answer 16

G-Glycols
O-Oxoproline(Tylenol)
L-Lactate
D-D Lactate(propylene glycol, Tylenol)

M-Methanol(solvents, window wash fluid)
A-Asa
R-Renal failure(burns, sweat, urinary issue)
K-Keto acidosis(DKA, starvation, chronic ETOH)

Question 17

Anion gap range

Answer 17

Uncorrected normal= 9-12
•[Na - (Cl + HCO3-)]
Corrected normal = 16-20
•[Na - (Cl + HCO3-)] + K

Question 18

Causes of Respiratory Alkalosis

Answer 18

**Respiratory Alkalosis is the 1st stage of shock

•Hyperventilation
•Anxiety
•Pregnancy
•Fever
•Hypoxia
•Initial stages of PE

*Increase in pH decrease in CO2

Question 19

Causes of Metabolically Alkalosis

Answer 19

**Worst situation possible/CASTISTROPHIC

•Loss of GI juices
•K wasting diuretics
•overuse of antacids

• increase in pH and HCO3-

Question 20

Tx of Metabolic acidosis

Answer 20

•Reduce GI suctioning
•Tx abnormal K+ & Na+(low), Ca++ & Mg++(high)
•Tx underlying causes
•Acetazolamide 500mg IV(used by climbers. Tx cerebral & pulmonary edema, optimizes HCO3- elimination)