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Chem/Physics-CP > Acid Base Disorders > Flashcards

Acid Base Disorders Flashcards

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1
Q

Is pH and pCo2 calculated or measured?

A

Measured using electrodes in an analyzer

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2
Q

Is HCO3 and BE calculated or measured?

A

Calculated from measured pH and pco2

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3
Q

What knowledge do you need to determine acid-base status?

A

patient history, pH, pco2, HCO3

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4
Q

What does calculating base excess do?

A

quantifies a metabolic disorder

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5
Q

What is purpose of anion gap?

A

helps determine the metabolic source. (MUDPILES and FUSEDCARS)

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6
Q

What does the “base” mean in base excess?

A

Sum of weak acid anions in plasma (hemoglobin, plasma proteins, phosphate, and bicarbonate)

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7
Q

What is the same as base excess?

A

Strong ion difference (SID)

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8
Q

How do you calculate base excess?

A

BE = calculated HCO3 - 24mEq/L (normal HCO3)

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9
Q

What are our standard conditions?

A

37 degrees C, pH 7.40, Pco2 40

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10
Q

What is our base excess at standard conditions?

A

0mmol/L !

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11
Q

What can base excess be a useful predictor for?

A

severity of critical illness associated with hypovolemic shock and consequent metabolic acidosis

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12
Q

What is normal base excess?

A

-2 to 2

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13
Q

3 possible mixed acid-base disorder scenarios

A
  1. pH 7.4 where respiratory and metabolic have opposite effects
  2. pH <7.35 and both derangements contribute to acidosis
  3. pH >7.45 and both derangements contribute to alkalosis
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14
Q

Respiratory acidosis

A

pH <7.40, paco2 > 45 (ROME)

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15
Q

Respiratory alkalosis

A

pH >7.4 paco2 <35 (ROME)

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16
Q

Metabolic acidosis

A

pH <7.4 HCO3 <22 (ROME)

17
Q

Metabolic alkalosis

A

pH >7.4 HCO3 >26 (ROME)

18
Q

If both HCO3 and Paco2 are not outside their normal ranges is the disorder compensated, partially compensated, or uncompensated?

A

uncompensated!

19
Q

If both HCO3 and paco2 are both outside their normal ranges and pH is not in normal range changed in the same direction are they compensated, partially compensated or uncompensated?

A

partially compensated!

20
Q

if both HCO3 and paco2 are outside their normal ranges and changed in the same direction and pH was in normal range is the disorder compensated, partially compensated, or uncompensated?

A

fully compensated!

21
Q

if HCO3 and PaCO2 change in opposite directions outside their normal ranges and pH is 7.4 what does that indicate?

A

Mixed disorder!

22
Q

How do you calculate anion gap?

A

AG =. Na - Cl - HCO3

23
Q

What acid base disorder would you increase RR/Vt on the vent?

A

respiratory acidosis

24
Q

What acid base disorder would giving Naloxone (Narcan) benefit?

A

respiratory acidosis

25
Q

Which acid base disorder would you give bronchodilators?

A

respiratory acidosis d/t bronchoconstriction (asthma, COPD exacerbation)

26
Q

Which acid base disorder would you give Dantrolene?

A

metabolic acidosis d/t malignant hyperthermia

27
Q

Which acid base disorder would you give NaHCO3?

A

metabolic acidosis

28
Q

aerobic metabolism produces what kind of acids?

A

volatile acids (carbonic acid)

29
Q

anerobic metabolism produces what kind of acids?

A

nonvolatile acids (lactic acid, hydrogen phosphate)

30
Q

physiological effects of acidemia

A

myocardial and smooth muscle depression

  1. reduction of contractility (decrease Co and BP- vasodilation)
  2. reduced peripheral vascular resistance
  3. less responsive to endogenous catecholamines
  4. threshold for vfib decreased
  5. coronary dilate, pulmonary constrict!

tissue hypoxia: despite rightward shift of Hgb affinity for O2

progressive hyperkalemia

  1. .6 mEq for .1 pH
  2. K+ out, H+ in
  3. risk for dysrhythmias

cns depression: increased CBF and intracranial HTN (CO2 narcosis)

31
Q

what makes up majority of anion gap?

A

albumin (4mg/dL)

32
Q

physiological effects of alkalemia

A

K+ in, H+ out (hypokalemia)
increases number of binding sites on plasma proteins for Ca2+ which decreases Ca2+ (circulatory depression and neuromuscular irritability)
decreases CBF (vasoconstriction)
increases SVR
precipitate coronary vasospasm
increase bronchial smooth muscle tone (bronchoconstriction)
decrease pulmonary vascular resistance (vasodilation)

33
Q

anesthetic considerations for respiratory alkalosis

A

prolong the duration of opioid induced respiratory depression, general ischemia can occur with reduction in CBF especially if hypotensive

34
Q

how long does max respiratory compensation for metabolic disorder to occur?

A

12-24 hours

35
Q

how long does max renal compensation for respiratory disorder to occur?

A

3-5 days

Chem/Physics-CP (3 decks)

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