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acid base disorders Flashcards

1
Q

normal arterial pH

A

7.4

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2
Q

normal plasma HCO3

A

24

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3
Q

normal arterial pCO2

A

40

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4
Q

normal plasma H+

A

36-44

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5
Q

when HCO3 is lost, pH will…

A

decrease

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6
Q

when pCO2 is lost, pH will…

A

increase

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7
Q

when H+ is lost, pH will…

A

increase

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8
Q

when pCO2 is gained pH will…

A

decrease

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9
Q

the lungs manage ___ and ___

A

PCO2 and pH

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10
Q

the kidneys manage ___ and ___

A

pH and HCO3

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11
Q

in metabolic acidosis, pH goes ____ and HCO3 goes ___

A

down

down

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12
Q

how are acid-base disorders diagnosed?

A

arterial blood gas interpretation

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13
Q

what is the mechanism behind metabolic acidosis?

A

either gaining an acid (H+) or losing HCO3

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14
Q

causes of anion-gap metabolic acidosis

A

lactic acidosis
ketoacidosis
renal insufficiency
aspirin

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15
Q

causes of non-anion gap metabolic acidosis

A

renal tubular acidosis
GI loss of HCO3 (diarrhea)
excess saline infusion

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16
Q

metabolic alkalosis mechanism

A

direct gain of HCO3, loss of H+

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17
Q

causes of metabolic alkalosis

A

vomiting
hypovolemia
thiazide diuretics
increased renal production of HCO3

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18
Q

respiratory acidosis mechanism

A

alveolar hypoventilation leads to CO2 retention

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19
Q

in metabolic alkalosis, pH goes ____ and HCO3 goes ___

A

up

up

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20
Q

in respiratory acidosis, pH goes ____ and PCO2 goes ___

A

down

up

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21
Q

in respiratory alkalosis, pH goes ____ and PCO2 goes ___

A

up

down

22
Q

causes of respiratory acidosis

A

airway obstruction
respiratory muscle weakness
CNS depression
(anything that would lead you not to breath fast or deeply enough)

23
Q

respiratory alkalosis mechanism

A

hyperventilation leads to too much CO2 being lost

24
Q

causes of respiratory alkalosis

A 
pain
panic attacks
pregnancy
pulmonary disease
pills (drugs)
problem with your brains
25
Q

7.32/10/98/8

what is each number on the ABG?

A

pH/ CO2/ O2/ HCO3

26
Q

7.32/10/98/8 acidosis or alkalosis?

A

acidosis (7.32)

27
Q

7.32/10/98/8

metabolic or respiratory

A

metabolic acidosis

7.32 is acidic
CO2=10 is low, but low CO2 would cause alkalosis
HCO3=8 is low which is driving the pH down

28
Q

7.32/10/98/8

appropriate compensation or not?

A

look at CO2- metabolic acidosis
(1.5 x 8) + 8 +/-2=
20 +/- 2 does not equal 10
so lungs are not compensating appropriately to try and increase pH

second disorder is low PCO2= respiratory alkalosis

29
Q

what is winter’s formula used for?

A

for metabolic acidosis ONLY: what CO2 should be if lungs are compensating appropriately

30
Q

winter’s formula

A

(1.5 x HCO3) + 8 +/-2

31
Q

which has faster compensatory changes–metabolic or respiratory disorders?
(think!)

A

in metabolic disorders, PCO2 compensates faster because ventilation can change quickly

respiratory disorders take longer to change urinary pH in response

32
Q

compensation mechanism in metabolic acidosis

A

low HCO3 leads to low pH
so respiratory rate increases to get rid of more CO2 and have an alkalotic effect and try to raise pH

use winters formula to see if there is appropriate compensation

33
Q

compensation mechanism in metabolic alkalosis

A

high HCO3 leads to high pH, respiratory compensation by decreasing respiratory rate to increase PCO2 and increase pH

34
Q

compensation mechanism in acute respiratory alkalosis or acidosis

A

trick question, there’s not really any compensation from the kidneys just that there may be some buffering of excess acid or base

35
Q

compensation mechanism of chronic respiratory acidosis

A

chronic high pCO2 and low pH leads to increased HCO3 by kidneys to try and raise pH

final pH will not be as acidic

36
Q

compensation mechanism of chronic respiratory alkalosis

A

chronic low CO2 and high pH leads to lower HCO3 by kidneys to compensate and try to lower pH

final pH will not be as alkalotic

37
Q

what is the anion-gap

A

represents the difference between the concentration of unmeasured anions (Cl-, HCO3-) and the the concentration of unmeasured cations (Na+, K+)

38
Q

what is a normal anion-gap

A

10-12

39
Q

high anion gap metabolic acidosis

A

anion gap > 12 due to increased concentration of acids like ketoacidosis or lactic acidosis

40
Q

formula to see if anion gap is high

A

2.5 x albumin (4)

41
Q

what is the delta delta ratio and when is it used

A

it is a ratio using the anion gap and serum bicarbonate to see if there is a second metabolic disorder occurring during high anion gap metabolic acidosis

42
Q

delta delta fomrula

A

measured- expected anion gap= number of bicarbs consumed to buffer anions
serum bicarb-anion gap= shows what bicarb should be and confirms presence of a secondary disorder

43
Q

if delta delta predicted bicarbonate is lower than expected, the other disorder present is …

A

non-gap metabolic acidosis

44
Q

if delta delta predicted bicarbonate is higher than expected, the other disorder present is …

A

metabolic alkalosis (or chronic respiratory acidosis)

45
Q

7.22/34/98/17

A

non-gap metabolic acidosis with appropriate respiratory compensation

46
Q

causes of non-gap metabolic acidosis

A

diarrhea, drugs, renal tubular acidosis

47
Q

urine anion gap formula

A

[Na] + [K] - [Cl]

48
Q

positive urine anion gap is due to

A

kidney problems-renal acidification

49
Q

negative urine anion gap is due to

A

GI loss of bicarbonate (diarrhea)

50
Q

how much should HCO3 change in chronic respiratory acidosis?

A

3.5 for every change of 10 in CO2 from normal

if CO2 is 60, it should be 40 so 2 changes of 10, 3.5 x2=7

51
Q

how much should HCO3 change in chronic respiratory alkalosis?

A

5 for every change of 10 in CO2 from normal

52
Q

diabetic ketoacidosis labs would present as…

A

high anion gap metabolic acidosis

high gap because of ketones

renal (17 decks)

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