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Acid base disorders Flashcards

1
Q

Where is H+ reabsorbed

A

Via distal tubule and collecting duct

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2
Q

Where does HCO3 enter/leave the body

A

HCO3 enter/leaves body via kidneys
Via proximal tubule

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3
Q

Henderson-Hasselbalch equation

A

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

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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

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5
Q

Consequences of acidosis: Nervous system

A

Obtundation

Coma

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6
Q

Consequences of acidosis: pulmonary

A

Hyperventilation

Dyspnea

Respiratory muscle fatigue

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7
Q

Consequences of acidosis: metabolism

A

Hyperkalemia

Insulin resistance

Inhibition of anaerobic glycolysis

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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

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9
Q

Acute hypercarbia compensation

A

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

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10
Q

Chronic hypercarbia compensation

A

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

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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

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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

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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

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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

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15
Q

Causes of high anion gap

A

Lactic acidosis
Ketoacidosis
Renal failure
Poisonings

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16
Q

Simple anion gap equation

A

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

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17
Q

Conventional anion gap equation

A

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

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18
Q

Treatment for metabolic acidosis

A

Treat the cause!!!

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

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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

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20
Q

Urgent/Emergent treatment for metabolic acidosis

A

consider hemodynamic monitoring
Guide fluid admin
Monitors cardiac function
Frequent lab

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21
Q

Respiratory alkalosis definition

A

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

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22
Q

Causes of resp alkalosis

A

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

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23
Q

Symptoms of resp alkalosis

A

Vasoconstriction;

lightheaded
Visual disturbance
Dizziness
Greater binding of calcium to albumin

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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

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25
Branches of facial nerve
two chickens bit my zebra temporal cervical buccal marginal mandibular zygomatic
26
Anesthesia management of resp alkalosis
Consequence of pain, anxiety, full bladder, agitation Poor mechanical ventilation strategy Therapeutic hyperventilation?
27
Metabolic alkalosis definition
“marked increase in plasma bicarb usually compensated for by an increase in carbon dioxide”
28
Causes of metabolic alk
Hypovolemia Vomiting NG suction Diuretic therapy Bicarb administration Hyperaldosteronism Renal or extrarenal causes Net loss of H+ or net gain of bicarb
29
Treatment for metabolic alk
depends on cause Volume depletion: saline fluid resuscitation Gastric loss: PPI’s Loop diuretics: add K+ sparing diuretics
30
pH 7.35, PCO2 48, HCO3 24
resp acidocis Increase bicarb
31
pH 7.58, PCO2 38, HCO3 29
Metabolic alkalosis Increase acid
32
pH 7.28, PCO2 42, HCO3 18
metabolic acidosis Increase bicarb
33
pH 7.48, PCO2 32, HCO3 22
resp alkalosis Decrease bicarb to make comp
34
PaO2= 80 -100 mmhg on 21%. on 100% oxygen pao2 should be ______
500 mmHg factor of 5
35
Excess production of H+ (in relation to hydroxyl ions)
Acidemia
36
Excess production of OH- (in relation to hydrogen ions)
Alkalemia
37
If both PaCO2 and/or HCO3 change in same direction
primary disorder with secondary compensation
38
If both PaCO2 and/or HCO3 change in different direction
mixed acid/base disorder
39
what is metabolic acidosis associated with
Assoc with alterations in transcellular ion pumps and ↑ ionized calcium Problems with ion pumps
40
Causes of R shift
decreased affinity for O2. increase pCO2 increase H+ (dec pH) inc 2,3 DPG inc Temp
41
Causes of L shift on oxy hb dissociation curve
42
Bicarb equation for calculating metabolic acidosis
(1.5 x HCO3-) + 8 If PaCO2 is higher than calculated CO2, compensation is inadequate; concomitant problem
43
Base excess equation for calculating metabolic acidosis compensation
44
hyperchloremic metabolic acidosis
Bicarb loss is countered by net gain of chloride ions
45
what can cause metabolic acidosis with a normal anion gap
Sodium chloride infusions Diarrhea Early renal failure
46
hyperchloremic metabolic acidosis
Bicarb loss is countered by net gain of chloride ions
46
Causes of L shift on oxy hb dissociation curve
increased affinity for O2 dec PCO2 dec H+ dec 2,3 DPG dec temp fetal hbg
46
what is metabolic acidosis associated with
Assoc with alterations in transcellular ion pumps and ↑ ionized calcium Problems with ion pumps
46
what can cause metabolic acidosis with a normal anion gap
Sodium chloride infusions Diarrhea Early renal failure
46
Bicarb equation for calculating metabolic acidosis compensation
(1.5 x HCO3-) + 8 If PaCO2 is higher than calculated CO2, compensation is inadequate; concomitant problem
46
Causes of R shift
decreased affinity for O2. increase pCO2 increase H+ (dec pH) inc 2,3 DPG inc Temp
46
Base excess equation for calculating metabolic acidosis compensation
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
Base excess equation for calculating metabolic acidosis compensation
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
what is metabolic acidosis associated with
Assoc with alterations in transcellular ion pumps and ↑ ionized calcium Problems with ion pumps
47
hyperchloremic metabolic acidosis
Bicarb loss is countered by net gain of chloride ions
47
Causes of R shift
decreased affinity for O2. increase pCO2 increase H+ (dec pH) inc 2,3 DPG inc Temp
47
Causes of L shift on oxy hb dissociation curve
increased affinity for O2 dec PCO2 dec H+ dec 2,3 DPG dec temp fetal hbg
48
Bicarb equation for calculating metabolic acidosis compensation
(1.5 x HCO3-) + 8 If PaCO2 is higher than calculated CO2, compensation is inadequate; concomitant problem
48
what can cause metabolic acidosis with a normal anion gap
Sodium chloride infusions Diarrhea Early renal failure
49
what can complicate using the anion gap equations
Complicated by hypoalbuminemia, hypophosphatemia the equations Frequently underestimates extent of disturbance
50
Levels to treat with sodium bicarbonate
pH < 7.1 or Bicarb < 10 meq/L
51
How does giving bicarb affect the acid base status
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
Other names for Metabolic alkalosis
Volume depletion or volume overload alkalosis

Principles (34 decks)

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