Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles > Acid base disorders > Flashcards

Acid base disorders Flashcards

1
Q

Where is H+ reabsorbed

A

Via distal tubule and collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where does HCO3 enter/leave the body

A

HCO3 enter/leaves body via kidneys
Via proximal tubule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Henderson-Hasselbalch equation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Consequences of acidosis: cardiovascular

A

Impaired contractility…7.2

Decreased contractility

Decreased arterial blood pressure

Sensitive to re-entry dysrhythmias

Decreased threshold for v-fib

Decreased responsiveness to catecholamines=7.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Consequences of acidosis: Nervous system

A

Obtundation

Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Consequences of acidosis: pulmonary

A

Hyperventilation

Dyspnea

Respiratory muscle fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Consequences of acidosis: metabolism

A

Hyperkalemia

Insulin resistance

Inhibition of anaerobic glycolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Respiratory acidosis definition

A

“An acute decrease in alveolar ventilation results in increase PaCO2”
To decrease pH to < 7.35
“resp failure”- extended number of days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Acute hypercarbia compensation

A

↑ PaCO2 of 10 mmHg = ↑ plasma HCO3- of 1 mmol/L (1meq/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Chronic hypercarbia compensation

A

↑ PaCO2 of 10 mmHg = ↑ plasma HCO3- by 3 mmol/L (3 meq/L)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tx for resp acidosis

A

Mechanical ventilation
If hypercarbia marked and CO2 narcosis present
Caution with chronic hypercarbia reversal….excessive bicarb causes CNS irritability…seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Metabolic acidosis definition

A

“ a lowered blood pH which stimulates the respiratory center to hyperventilate”
Respiratory compensation does not fully counter excessive acid production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Equations for compensated metabolic acidosis

A

1.5 x HCO3- + 8
If PaCO2 is higher than 26, compensation is inadequate; concomitant problem

For every 1 mEq/L ↓ in BE, PaCO2 should fall 1.2 mm Hg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

High anion gap

A

Additional acid is added to extracellular space

Acid dissociates, H+ ion combines with bicarb….carbonic acid…decreased available measurable bicarb= decreasing anion concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causes of high anion gap

A

Lactic acidosis
Ketoacidosis
Renal failure
Poisonings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Simple anion gap equation

A

Na+ - (Cl- + HCO3-) = 12-14 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Conventional anion gap equation

A

(Na+ + K+) - (Cl- + HCO3-) = 14-18 mEq/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment for metabolic acidosis

A

Treat the cause!!!

Ketoacidosis: insulin and fluids
Lactic acidosis: improve tissue perfusion
r/t renal failure: dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Full bicarb Correction Dos

A

Full Correction Dose (mmol) = 0.3 x base deficit (mmol/L) x wt(kg)

Give ½ dose and reassess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Urgent/Emergent treatment for metabolic acidosis

A

consider hemodynamic monitoring
Guide fluid admin
Monitors cardiac function
Frequent lab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Respiratory alkalosis definition

A

an acute increased alveolar ventilation
Results in decreased PaCO2
pH > 7.45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of resp alkalosis

A

Pregnancy
High altitude
Iatrogenic hyperventilation (during perioperative period)
Salicylate overdose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Symptoms of resp alkalosis

A

Vasoconstriction;

lightheaded
Visual disturbance
Dizziness
Greater binding of calcium to albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Signs/Sx of hypocalcemia due to resp alkalosis

A

Paresthesia, muscle spasm, cramps, tetany, circumoral numbness, seizures
Trousseau’s sign; bp cuff -> carpopedal spasm
Chvostek’s sign; facial nerve tap -> irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Branches of facial nerve

A

two chickens bit my zebra

temporal
cervical
buccal
marginal mandibular
zygomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Anesthesia management of resp alkalosis

A

Consequence of pain, anxiety, full bladder, agitation
Poor mechanical ventilation strategy
Therapeutic hyperventilation?

27
Q

Metabolic alkalosis definition

A

“marked increase in plasma bicarb usually compensated for by an increase in carbon dioxide”

28
Q

Causes of metabolic alk

A

Hypovolemia
Vomiting
NG suction
Diuretic therapy
Bicarb administration
Hyperaldosteronism
Renal or extrarenal causes
Net loss of H+ or net gain of bicarb

29
Q

Treatment for metabolic alk

A

depends on cause
Volume depletion: saline fluid resuscitation
Gastric loss: PPI’s
Loop diuretics: add K+ sparing diuretics

30
Q

pH 7.35, PCO2 48, HCO3 24

A

resp acidocis
Increase bicarb

31
Q

pH 7.58, PCO2 38, HCO3 29

A

Metabolic alkalosis
Increase acid

32
Q

pH 7.28, PCO2 42, HCO3 18

A

metabolic acidosis
Increase bicarb

33
Q

pH 7.48, PCO2 32, HCO3 22

A

resp alkalosis
Decrease bicarb to make comp

34
Q

PaO2= 80 -100 mmhg on 21%.
on 100% oxygen pao2 should be ______

A

500 mmHg

factor of 5

35
Q

Excess production of H+ (in relation to hydroxyl ions)

A

Acidemia

36
Q

Excess production of OH- (in relation to hydrogen ions)

A

Alkalemia

37
Q

If both PaCO2 and/or HCO3 change in same direction

A

primary disorder with secondary compensation

38
Q

If both PaCO2 and/or HCO3 change in different direction

A

mixed acid/base disorder

39
Q

what is metabolic acidosis associated with

A

Assoc with alterations in transcellular ion pumps and ↑ ionized calcium
Problems with ion pumps

40
Q

Causes of R shift

A

decreased affinity for O2.

increase pCO2
increase H+ (dec pH)
inc 2,3 DPG
inc Temp

41
Q

Causes of L shift on oxy hb dissociation curve

A
42
Q

Bicarb equation for calculating metabolic acidosis

A

(1.5 x HCO3-) + 8

If PaCO2 is higher than calculated CO2, compensation is inadequate; concomitant problem

43
Q

Base excess equation for calculating metabolic acidosis compensation

A
44
Q

hyperchloremic metabolic acidosis

A

Bicarb loss is countered by net gain of chloride ions

45
Q

what can cause metabolic acidosis with a normal anion gap

A

Sodium chloride infusions
Diarrhea
Early renal failure

46
Q

hyperchloremic metabolic acidosis

A

Bicarb loss is countered by net gain of chloride ions

46
Q

Causes of L shift on oxy hb dissociation curve

A

increased affinity for O2

dec PCO2
dec H+
dec 2,3 DPG
dec temp
fetal hbg

46
Q

what is metabolic acidosis associated with

A

Assoc with alterations in transcellular ion pumps and ↑ ionized calcium
Problems with ion pumps

46
Q

what can cause metabolic acidosis with a normal anion gap

A

Sodium chloride infusions
Diarrhea
Early renal failure

46
Q

Bicarb equation for calculating metabolic acidosis compensation

A

(1.5 x HCO3-) + 8

If PaCO2 is higher than calculated CO2, compensation is inadequate; concomitant problem

46
Q

Causes of R shift

A

decreased affinity for O2.

increase pCO2
increase H+ (dec pH)
inc 2,3 DPG
inc Temp

46
Q

Base excess equation for calculating metabolic acidosis compensation

A

For every 1 mEq/L ↓ in BE, PaCO2 should fall 1.2 mm Hg

if this is true then it is compensated

Otherwise compensation inadequate

47
Q

Base excess equation for calculating metabolic acidosis compensation

A

For every 1 mEq/L ↓ in BE, PaCO2 should fall 1.2 mm Hg

if this is true then it is compensated

Otherwise compensation inadequate

47
Q

what is metabolic acidosis associated with

A

Assoc with alterations in transcellular ion pumps and ↑ ionized calcium
Problems with ion pumps

47
Q

hyperchloremic metabolic acidosis

A

Bicarb loss is countered by net gain of chloride ions

47
Q

Causes of R shift

A

decreased affinity for O2.

increase pCO2
increase H+ (dec pH)
inc 2,3 DPG
inc Temp

47
Q

Causes of L shift on oxy hb dissociation curve

A

increased affinity for O2

dec PCO2
dec H+
dec 2,3 DPG
dec temp
fetal hbg

48
Q

Bicarb equation for calculating metabolic acidosis compensation

A

(1.5 x HCO3-) + 8

If PaCO2 is higher than calculated CO2, compensation is inadequate; concomitant problem

48
Q

what can cause metabolic acidosis with a normal anion gap

A

Sodium chloride infusions
Diarrhea
Early renal failure

49
Q

what can complicate using the anion gap equations

A

Complicated by hypoalbuminemia, hypophosphatemia

the equations Frequently underestimates extent of disturbance

50
Q

Levels to treat with sodium bicarbonate

A

pH < 7.1 or Bicarb < 10 meq/L

51
Q

How does giving bicarb affect the acid base status

A
  1. Reacts with H+… generates CO2 …diffuses intracellularly and decreases pH more
  2. In chronic metabolic acidosis, acute pH changes negates right shift of curve (Bohr effect) and causes tissue hypoxia
52
Q

Other names for Metabolic alkalosis

A

Volume depletion or volume overload alkalosis

Principles (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions