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Pathological Liars > Acid-Base Disorders + ABG Interpretation > Flashcards

Acid-Base Disorders + ABG Interpretation Flashcards

1
Q

What is the most important ECF buffer system? What does it do?

A
  • Bicarbonate - Carbonic Acid Buffer System
  • maintains desired pH of ECF or blood
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2
Q

A buffer system of any kind involves the pairing of:

A

an acid + weak base

OR

a weak acid + base

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3
Q

What kind of mechanism is involved with the Bicarb/Carbonic System? What does this mechanism do?

A

physiological mechanisms
- in body to adjust the levels of both “sides” of the acid/base pair
- between the opposite chemicals, H+ ions may be absorbed or donated to the solution as needed
- occurs in response to changes in pH

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4
Q

What is often measured as a substitute for carbonic acid concertation in the Bicarb/Carbonate System?

A

Since carbonic acid has a tendency to dissolve into gaseous form in the bloodstream, CO2 (PaO2) is often measured as a substitute

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5
Q

Equation and component of each side

A

CO2 + H2O —–> H2CO3 —–> H+ + HCO3-

Left side: respiratory component - physiological adjustment by lungs
Right side: metabolic/kidney component - physiologic adjustment by kidneys

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6
Q

Are buffer systems a permanent fix for pH imbalances?

A

No - only temporary fix

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7
Q

Respiratory system vs. kidney adjustment time

A

Respiratory can adjust CO2 blood level within MINUTES/HOURS

Kidneys are slower to adjust H+ and HCO3- blood levels: HOURS/DAYS

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8
Q

Acid/Base Imbalances are characterized by 2 things:

A
  1. primary cause
  2. pH problem
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9
Q

Primary Cause

A
  • the initiating even that causes the acid/base imbalance

categorized as respiratory or metabolic
- Respiratory: affect gas exchange –> changes in CO2 blood level –> imbalance
- Metabolic: lot more variety; can cause changes in HCO3- (bicarb) or H+ levels

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10
Q

pH problem

A

classified as:
- acidosis (decrease in pH: left side of chart)
- alkalosis (increase in pH: right side of chart)

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11
Q

Compensation

A
  • a mechanism that attempts to balance the state created by the primary cause
  • observed when components of opposite sides of the buffer CHANGE to minimize or balance out the initial pH imbalance
  • goal: to push pH back towards 7.4
  • temporary
  • permits survival while body attempts to fix problem or medical intervention occurs
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12
Q

In all acid/base disorders, the ______ is impaired

A

clearance of CO2 out of the blood
- due to either reduced ventilation or reduced gas exchange at alveoli

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13
Q

Respiratory Acidosis starting situation

A

pH is less than 7.35

PaCO2 is greater than 45

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14
Q

Respiratory Acidosis issue

A

decreased CO2 expiration by lungs leaves too much CO2 in the blood
- too acidic
- CO2 accumulation makes pH decrease

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15
Q

Respiratory Acidosis - compensatory action

A

the kidneys will either:
- retain HCO3-

OR

  • excretes H+ ions
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16
Q

Respiratory Acidosis - causes

A

hypoventilation
- breath slow –> less air pushed out
- narcotic/sedative overdose
- COPD
- muscular disorders resulting in respiratory paralysis
- pulmonary edema

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17
Q

Respiratory Acidosis - treatment

A

restore effective ventilation - give O2

18
Q

Respiratory Alkalosis starting situation

A
  • pH is greater than 7.45 (right side)
  • PaCO2 is less than 35 (right side)
19
Q

Respiratory Alkalosis issue

A

increased CO2 output makes blood level CO2 decrease

too alkaline

20
Q

Respiratory Alkalosis - compensatory action

A

kidneys will excrete more HCO3- or retain H+

21
Q

Respiratory Alkalosis - cause

A

hyperventilation (exhale quickly)
- increase in heart rate or tidal volume (panic attack)

brain injury or tumor

some lung diseases

22
Q

Respiratory Alkalosis - signs/symptoms

A

neurological
- dizziness
- confusion
- seizures
- numbness and tingling in extremities

23
Q

Respiratory Alkalosis - treatment

A

fix underlying cause: breathe into paper bag is hyperventilating

24
Q

Metabolic Acidosis starting situation

A
  • pH is less than 7.35
  • HCO3- is less than 22
25
Q

Metabolic Acidosis issue

A

loss of HCO3-

or

retention of H+

26
Q

Metabolic Acidosis - compensatory action

A

lungs will hyperventilate (blow off more CO2) to excrete excess CO2 out of blood

27
Q

Metabolic Acidosis - causes

A

bicarbonate loss (diarrhea)

increased acid production
- lactic acidosis
- diabetic ketoacidosis
- ingestion of acidic poisons
- acute or chronic renal failure

28
Q

Metabolic Acidosis - signs/symptoms

A
  • GI disturbance
  • CNS changes (disorientation)
  • bradycardia
  • dysrhythmias
  • hyperventilation
29
Q

Metabolic Acidosis - treatment

A
  • IV NAHCO3
  • replace fluids and other electrolytes
30
Q

Metabolic Alkalosis starting situation

A
  • pH is greater than 7.45
  • HCO3- is greater than 26
31
Q

Metabolic Alkalosis issue

A

retention of HCO3-

OR

loss of H+

  • dysfunctional metabolic process
32
Q

Metabolic Alkalosis - compensatory action

A

lungs will hyperventilate (blow off less CO2)

33
Q

Metabolic Alkalosis - causes

A
  • vomiting: loss of hydrochloric acid
  • excess ingestion or administration of bicarbonate or alkaline substances
34
Q

Metabolic Alkalosis - signs/symptoms

A
  • hypokalemia or fluid volume deficit
  • mental status changes: confusion, hypoventilation, hyperactive reflexes
35
Q

Metabolic Alkalosis - treatment

A

replacement of necessary electrolytes and fluids

36
Q

What are arterial blood gases and what does the information tell us?

A
  • the numbers and lab values we use when patients gets their blood drawn from their artery
  • tells us which of the 4 acid/base imbalance disorders they have
37
Q

4 steps in ABG interpretation

A
  1. Assess PaO2
  2. Asses pH
  3. Determine Initiating system
  4. Determine Compensatory action - if one
38
Q

What is the partial pressure of O2?

A

the concentration of our dissolved and free floating molecules in our plasma
- unattached to hemoglobin
- only type able to diffuse across the capillary bed + provide cells/tissues with O2

39
Q

Partial Compensation

A

if OPPOSITE system (not initiating system) is outside normal range in the OPPOSITE direction

40
Q

Successful/Complete Compensation

A

if OPPOSITE system (not initiating system) is outside normal range in the OPPOSITE direction

AND

pH is in the normal range

41
Q

No Compensation

A

If OPPOSITE system (not initiating system) is INSIDE normal range

Pathological Liars (7 decks)

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