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Acid base disorder Flashcards

1
Q

Arterial Sample

Peripheral venous sample

Central Venous Sample

A
  • 7.35-7.45
  • pH is usually .02-.04 units lower than in arterial, HCO3 concentration 1 to 2 meq/L higher and PCO2 is usually 3 to 8 mmHg higher
  • Usually 0.03 to 0.05 pH units lower and PCO2 is 4 ro 5 mmHg higher. Little or no incease in serum
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2
Q

An arterial pH below the norm

less than 7.35

A

Acidemia

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3
Q

An arterial pH above normal range

>7.45

A

Alkalemia

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4
Q

A process that tends to lower the extracellular fluid pH (H ion concentration increases). THis can be caused by a fall in serum bicarb concentration and or an elevation in PCO2

A

Acidosis

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5
Q

A process that tends to raise the extracellular fluid pH (H+ concentration is lower). This can be caused by increased serum bicarb and/or fall in PCO2

A

Alkalosis

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6
Q

HCO3 <21 and/or PCO2 > 45

A

Acidosis

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7
Q

HCO3 > 30 and/ or PCO2 <35

A

Alkalosis

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8
Q

A disorder that causes reductions in the serum HCO3 concentration and pH

A

Metabolic acidosis

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9
Q

A disorder that causes elevations in the serum HCO3 concentration and pH

A

Metabolic Alkalosis

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10
Q

A disorder that causes an elevation in arterial PCO2 and a reduction in pH

A

Respiratory acidosis

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11
Q

A disorder that causes a reduction in arterial PCO2 and an increase in pH

A

Respiratory alkalosis

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12
Q

The presence of one of the Metabolic/Respiratory disorders with the appropriate respiratory or renal compensation for that disorder.

A

Simple Acid-Base Disorder

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13
Q

The presence of more than one acid-base disorder

A

Mixed disorder

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14
Q

Arterial pH

Normal

Alkalemia/Alkalosis

Acidemia/Acidosis

Panic values

A
  • 7.35-7.45
  • >7.45
  • <7.35
  • >7.55 or <7.25
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15
Q

Acidemia produces __ K+

Alkalemia produces ___ K+

pH change of 0.1 is associated with __ change in serum K+

Prolonged acidosis:?

A
  • Higher
  • Lower
  • 0.6 change in opposite direction
  • Renal K+ wasting
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16
Q

Arterial pCO2

Normal

Acidemia/acidosis

Alkalemia/alkalosis

Increased with ____ respiratory rate or tidal volumes

Decreased with ____ respiratory rate or tidal volume

A
  • 35-45 mmHg
  • >45 mmHg
  • <35 mmHg
  • decreased
  • increased
17
Q

Arterial pO2

normal

Increased with ____ respiratory rate

Decreased with ___ respiratory rate

Panic value?

A

80-100

Increased

Decreased

<60mmHg

18
Q

Bicarb

Arterial serum normal range

Alkalemia/Alkalosis

Acidemia/Acidosis

A

21-30

>30

<21

19
Q

O2 saturation

Normal

Goal>__ with mechanical ventilation or > __ ambulatory

20
Q

In pts with metabolic acidosis, determine if the anion gap is?

Calculated by?

A
  • elevated >12
  • Cation - Anion
21
Q

Six step process for determining acid - base disorder

A
  1. Is the pt acidemic or alkalemic?
  2. Is the overriding disturbance respiratory or metabolic?
  3. If respiratory is it acute or chronic?
  4. If metabolic is there a high anion gap?
  5. If metabolic is there a respiratory system compensating appropriately?
  6. Is there a second metabolic disturbance present?
22
Q

3 step for determining acid-base disorder?

A
  1. Is there a problem?
    1. Determine pH
  2. Establish the primary process/diagnosis (metabolic vs. respiratory)
  3. Determine compensation
23
Q

Respiratory vs metabolic

A
  • pH matching pCO2 (lungs)
    • pCO2 >45 or <35
    • pH 7.55 and pCO2 25 then = respiratory alkalosis
  • pH matching HCO3-
    • >30 or <21 and matches the pH
    • pH 7.3 and HCO3- 16 = metabolic acidosis
24
Q

Determining compensation

A
  • Find the value that does not match the pH and determine if the body has attempted to correct the problem
  • If pCO2 or HCO3- are abnormal in the opposite direction of the pH then there is compensation
  • if pCO2 or HCO3- are not abnormal then there is no compensation
  • Complete compensation occurs when the pH is normal but the pCO2 and HCO3- are abnormal (can also be mixed)
25
Q

Metabolic compensation

Acute and Chronic Hypercapnia

A
  • HCO3 increases 1 for each 10 mmHg increase in PaCO2>40
  • HCO3- increases 3.5 for 10 mmHg increase in PaCO2 >40
26
Q

Metabolic compensation

Acute/Chronic Hypocapnia

27
Q

Metabolic acidosis

Alkalosis

Respiratory acidosis/alkalosis

A
  • A disorder that causes reductions in the serum HCO3 concentration and pH.
  • A disorder that causes elevations in the serum HCO3 concentration and pH.
  • A disorder that causes an elevation in arterial PCO2 and a reduction in pH.
  • A disorder that causes a reduction in arterial PCO2 and an increase in pH.
28
Q

Metabolic acidosis

Anion gap

MUDPILES- Anion Gap

USED CARS Non-anion gap

A
  • M-Methanol
  • U-Uremia
  • D-DKA
  • P- eraldehyde
  • I- Intoxication
  • L- Lactic acidosis
  • E- Ethylene Glycol
  • S-Salicylates
  • U-Uterosigmoid diversion
  • S-Saline
  • E-EtOH
  • D- Diarrhea
  • C- Carbonic anhydrase inhibitors
  • A-Alcohol, Addisons disease/Cushing
  • R- Renal Tubular Acidosis
  • S-Saline?
29
Q

Metabolic Alkalosis

A
  • Alkali ingestion
  • Vomiting or NG suction
  • Fluid volume contraction
  • Hypokalemia
  • Cushings disease, glucocorticoids, mineralocorticoids, post-chronic hypercapnia
  • Massive blood transfusion (whatpreservative?)
  • Ingestion or administration of bicarb
    • Mile-alkali syndrome
30
Q

Respiratory Acidosis

Hyperventilation

31
Q

Respiratory alkalosis

32
Q

Metabolic Acidosis

Gap or non gap?

A

Gap >12

Non gap 12 or less

33
Q

Step 3a determine gap

A

In pts with metabolic acidosis, determine if anion gap is elevated

Cation-Anion

>12 gap, metabolic acidosis

662 (24 decks)

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