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PT: Hematology & Pulmonary > Acid/Base Disorders > Flashcards

Acid/Base Disorders Flashcards

1
Q

acidity is determined by the ____ ion concentration

A

H+

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2
Q

degree of acidity is described by the ____

A

pH

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3
Q

dissociation of acid/base pairs is dependent on ____ and ____

A
  1. dissociation constant 2. relative concentration of acid/base in solution
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4
Q

normal pH

A

7.4 (7.35 - 7.45)

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5
Q

normal PaCO2

A

40 (35-45)

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6
Q

normal HCO3-

A

24 (22-26)

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7
Q

effect of increase PaCO2

A

increase in acid content (decrease pH)

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8
Q

effects of decreased PaCO2

A

decrease in acid content (increase pH)

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9
Q

effects of increased HCO3

A

increase in base content (increase pH)

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10
Q

effected of decreased HCO3

A

decrease in base content (decrease pH)

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11
Q

pH is determined by the ratio of what?

A

HCO3 and PaCO2

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12
Q

Key extracellular buffers

A

carbonic acid/bicarb plasma proteins hemoglobin phosphates

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13
Q

What part is under respiratory control?

A

CO2

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14
Q

What part is under kidney control?

A

H+ and HCO3-

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15
Q

How much volatile acids are produced daily and excreted as CO2?

A

12,000 - 15,000 mEq

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16
Q

How are volatile gases eliminated?

A

as CO2 in lungs

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17
Q

How are nonvolatile acids eliminated?

A

kidneys

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18
Q

How much non-volatile acids ae produced daily and excreted by kidneys?

A

1 mEq/kg/day

4,500 mEq bicarb delivered to nephron and must be reabsorbed

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19
Q

the pH of body fluids is determined by what (3)

A
  1. amount of acid produced
  2. buffering capacity
  3. acid excretion by lungs and kidneys
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20
Q

What can be altered in respiratory system to accommodate acute changes in pH?

A

respirtory rate

tidal volume

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21
Q

What can be altered in kidney system to adjust pH?

A

change in bicarb

New HCO3 through ammoniagenesis

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22
Q

Are the lungs or kidney more responsive to acute acid/base changes?

A

lungs!

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23
Q

t/f the body will try to normalize pH and will return to normal pH

A

False!

NEVER return to normal pH

**except chronic respiratory alkalosis

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24
Q

Which compensation is faster? respiratory or renal?

A

Respiratory! (hours)

renal (days)

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25
Q

what equation is used to measure respiratory compensation?

A

Winters formula

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26
Q

Is insulin resistance a consequence of acidemia or alkalemia?

A

acidemia

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27
Q

Is impaired cardiac contractility a consequence of acidemia or alkalemia?

A

acidemia

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28
Q

Is bradycardia and heart block a consequence of acidemia or alkalemia?

A

acidemia

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29
Q

Is increase pulmonary vascular resistance a consequence of acidemia or alkalemia?

A

acidemia

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30
Q

Is hyperkalemia a consequence of acidemia or alkalemia?

A

acidemia

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31
Q

Is increased protein degradation a consequence of acidemia or alkalemia?

A

acidemia

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32
Q

Is reduction in ventricular fib threshold a consequence of acidemia or alkalemia?

A

acidmeia

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33
Q

Is arteriolar vasoconstriction a consequence of acidemia or alkalemia?

A

alkalemia

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34
Q

Is reduced coronary blood flow a consequence of acidemia or alkalemia?

A

alkalemia

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35
Q

Is reduced cerebral blood flow a consequence of acidemia or alkalemia?

A

alkalemia

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36
Q

Is hypokalemia a consequence of acidemia or alkalemia?

A

alkalemia

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37
Q

Is hypomagnesemia a consequence of acidemia or alkalemia?

A

alkalemia

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38
Q

Is hypophosphatemia a consequence of acidemia or alkalemia?

A

alkalemia

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39
Q

Is hypocalcimia a consequence of acidemia or alkalemia?

A

alkalemia

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40
Q

Is seziures, lethargy, delirium a consequence of acidemia or alkalemia?

A

alkalemia

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41
Q

Where do you get an arterial blood gas sample?

A

Radial artery

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42
Q

Potential complications of getting arterial blood gas (ABG)

A
  • site pain
  • hematoma
  • infection
  • arterial occlusion or thrombosis
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43
Q

Potential limitations with collection and analysis of ABG

A

sample should be drawn, chilled and analyzed within 30 mins

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44
Q

Acidemic pH

A

<7.35

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45
Q

alkalemic pH

A

>7.45

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46
Q

PaCO2 of respiratory acidosis

A

>40

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47
Q

PaCO2 of respiratory alkalosis

A

<40

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48
Q

HCO3- of metabolic acidosis

A

<22

49
Q

HCO3- of metabolic alkalosis

A

>26

50
Q

What acromyn do you use for acute respiratoyr acidosis?

A

CAPPHN

51
Q

Acute respiratory acidosis causes (acronym)

A

CNS depression

Airway obstruction

Pulmonary edema

Pneumonia

Hemo/pneumothorax

Neuromuscular

**anything causing hypoventilation

52
Q

3 overall causes of acute respiratory acidosis

A
  • inadequate minute ventilation
  • increased dead space ventilation (COPD)
  • increased carb metabolism (TPN)
53
Q

Clinical presentation of acute respiratory acidosis

A
  • altered mental status
  • headache
  • papilledema
  • focal paresis
  • seizures
  • coma
54
Q

treatment of acute respiratory acidosis

A
  • restore ventilation
  • oxygen
55
Q

Do you give bicarb to acute respiratory acidosis?

A

not routinely necessay

may precipiate metabolic alkalosis or suppres patient ability to breath

56
Q

What acronym do you use for acute respiratory alkalosis?

A

CHAMPS

57
Q

CAPPHN - C

A

CNS depression

COPD

(acute resp acidosis)

58
Q

CAPPHN - A

A

Airway obstruction

Apnea

ARDS

(acute resp acidosis)

59
Q

CAPPHN - P x 2

A

pulmonary edema

pneumonia

(acute resp acidosis)

60
Q

CAPPHN - H

A

hemo/pneumonthorax

Hypnotics/sedative

(acute resp acidosis)

61
Q

CAPPHN - N

A

Neuromuscular (acute resp acidosis)

62
Q

CHAMPS - C

A

CNS disease (acute resp alkalosis)

63
Q

CHAMPS - H

A

hypocapnia

Hepatic encephalopathy

Hypoxia

(acute resp alkalosis)

64
Q

CHAMPS - A

A

Anxiety

altitude sickness

(acute resp alkalosis)

65
Q

CHAMPS - M

A

mechanical ventilation (acute resp alkalosis)

66
Q

CHAMPS - P

A

progesterone/PE

pregnancy

(acute resp alkalosis)

67
Q

CHAMPS - S

A

salicylate/sepsis (acute resp alkalosis)

68
Q

Causes of acute respiratory alkalosis (acronym)

A

CNS disease

Hypocapnia

Anxiety

Mechanical ventilation

Progesterone/PE

Salicylate

69
Q

treatment of respiratory alkalosis

A

treat underlying condition

  • slow down breathing (analgesia, anxiolytics)
  • correct hypoxemia
  • if ventilated, make adjustments (TV or RR)
70
Q

T/F with compensatory responses the body will return to normal pH

A

False! try to normalize pH, never return to normal

EXCEPT chronic resp alkalosis

71
Q

Compensaory mechanisms are dependent on appropriately working _____ and _____

A

kidneys

lungs

72
Q

Is respirator or renal compensation quicker?

A

respiratory (hours)

renal (days

73
Q

3 main causes of chronic respiratory acidosis

A
  • chronic lung disease
  • chronic neuromuscular disease
  • chronic respiratory center depression
74
Q

Chronic lung disease causes of chronic respiratory acidosis

A

COPD

pulmonary fibrosis

interstitial pulmonary disease

75
Q

chronic neuromuscular disease causes of chronic respiratory acidosis

A

Guillian Barre

ALS

Myasthenia Gravis

76
Q

Management of chronic respiratory acidosis

A
  • clear secretions
  • relieve bronchospasm (bronchodilators, steroids)
  • aggressively treat CHF or pulm infections
  • avoid excessive O2 delivery
77
Q

Do you use winters formula in respiratory or metabolic disorder?

A

metabolic

78
Q

After winters equation, if measured PaCO2 is < than expected then what?

A

co-existing respiratory alkalosis

79
Q

After winters equation, if measured PaCO2 is > than expected then what?

A

co-exisiting respiratory acidosis

80
Q

A high anion gap means here is a loss of _____ and indicates _____

A

Bicarb

acidosis

81
Q

When there is an ______ in acid, there is an increase in anion gap because _____ is decrease in response to _____ the excess acid

A

increase

bicarb

buffer

82
Q

Acronym for increase anion gap

A

MUDPILERS

83
Q

MUDPILERS - M

A

Methanol/metformin (increased AG)

84
Q

MUDPILERS - U

A

uremia (increased AG)

85
Q

MUDPILERS - D

A

DKA (increased AG)

86
Q

MUDPILERS - P

A

Paraldehyde (incrased AG)

87
Q

MUDPILERS - I

A

isoniazid/iron

(increased AG)

88
Q

MUDPILERS - L

A

Lactic acid (increased AG)

89
Q

MUDPILERS - E

A

ethylene glycol/ethanol (increased AG)

90
Q

MUDPILERS - R

A

Renal failure (increased AG)

91
Q

MUDPILERS - S

A

Salicylates (increased AG)

92
Q

limitations of anion gap

A

hypoalbuminemia can affect observed AG

93
Q

Measured AG and hypoalbuminemia

A

decrease 3 mmol for ever 1 g/dL decrease in albumin

94
Q

acronym for non-anion gap

A

HARDUPS

95
Q

HARDUPS - H

A

hyperalimentation

HCl admin

(non-AG)

96
Q

HARDUPS - A

A

acetazolamide (non-AG)

97
Q

HARDUPS - R

A

Renal tubular acidosis

renal bicarb loss

CAIs

(non-AG)

98
Q

HARDUPS - D

A

diarrhea (non-AG)

99
Q

HARDUPS - U

A

uretero-pelvic shunt

ureteral diversion

(non-AG)

100
Q

HARDUPS - P

A

post-hypocapnia

101
Q

HARDUPS - S

A

spironolactone (non-AG)

102
Q

What is delta gap used for?

A

assist determination for mixed acid/base disorders

103
Q

Delta gap + measured HCO3 = ____ or higher then what is occuring?

A

28

underlying concurrent metabolic alkalosis

104
Q

delta gap + measured HCO3 < ____ then what is occuring?

A

20

underlying concurrent nongap metabolic acidosis

105
Q

If there is an underlying nongap metabolic acidosis what could be the causes?

A

GI loss bicarb (diarrhea)

renal loss bicarb (RTA, ATN, hypoaldosterone)

dilutional (post resuscitation)

106
Q

Metabolic acidosis treatment

A
  • correct the cause
  • renal loss: give bicarb (not in AG acidosis)
  • control diarrhea
  • DKA: fluids, insulin
  • lactic acidosis: improve hemodynamics
  • intoxication: treat
107
Q

Would you use bicarb in metabolic acidosis?

A

Yes, but not in anion gap acidosis

108
Q

acronym for metabolic alkalosis

A

CLEVERPD

109
Q

CLEVERPD - C

A

contraction (metabolic alkalosis)

110
Q

CLEVERPD - L

A

licorice (metabolic alkalosis)

111
Q

CLEVERPD - E x 2

A

excess alkali

endocrine (Conn/cushing)

(metabolic alkalosis)

112
Q

CLEVERPD - V

A

vomiting (metabolic alkalosis)

113
Q

CLEVERPD - R

A

refeeding (metabolic alkalosis)

114
Q

CLEVERPD - P

A

post-hypercapnia (metabolic alkalosis)

115
Q

CLEVERPD - D

A

diuretics (metabolic alkalosis)

116
Q

metabolic alkalosis causes (acronym)

A

Contraction

Licorice

Endocrine (conn/cushing)

Vomiting

Excess alkali

Refeeding

Post-hypercapnia

Diuretics

117
Q

Non-anion gap causes (acronym)

A

Hyperalimentation/HCl admin

Acetazolamide

Renal bicarb loss/renal tubular acidosis

Diarrhea

Uretero-pelvic shunt/diversion

Post-hypocapnia

Spironolactone

118
Q

Anion gap causes (acronym)

A

Methanol/metformin

Uremia

  • *D**KA
  • *P**araldehyde

Isoniazide/irone

Lactic acid

Ethylene glycol/ethanol

Renal failure

Salicylates

119
Q

metabolic alkalosis treatment

A

treat underlying disease

  • rehydrate with normal saline with K
  • if excess mineralocorticoid acvitiy: aldosterone inhibition (spironolactone, amiloride, triamterene)

PT: Hematology & Pulmonary (8 decks)

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