Acid-Base Disorders - fiore Flashcards
What maintains the bicarbonate buffer system
Lungs and Kidneys
Co2= acid
HCO3 = Base
What are the different acid based disorders
Respiratory acidosis
respiratory alkalosis
metabolic acidosis
metabolic alkalosis
how are acid based disorders characterized
by the PRIMARY abnormality
(possible to have mixed disorder)
What is respiratory acidosis
pH < 7.4secondary to respiratory disturbance
acid retention (CO2)
what is the hallmark of respiratory acidosis
increased PaCO2
what is respiratory alkalosis
pH > 7.4 secondary to respiratory distubance
excess acid loss (CO2)
what is hallmarked by decreased PaCO2
Respiraotry Alkalosis
what is metablic acidosis
pH < 7.4 secondary to ‘metabolic’ disturbance
decreased acid excretion - accumulation
increased acid load (ketones, lactate)
redcued level of base (HCO3)
how are metabolic acidosis classified
non-anion gap metabolic acidosis
anion gap metabolic acidosis
What is the normal AG
8-15
when is Anion Gap (AG) considered Wide
> 15
problem related to other acids
what is assoicated with wide AG
Kenoacidosis
lactic acidosis
other toxins
renal fialure (late stage)
What are causes of Non-Anion Gap Metabolic Acidosis
HARDUPS
* Hyperalimentation (IV nutrition)
* acetazolamide, Addison’s
* Renal Tubular acidosis
* diarrhea, dehydration, diuretics
* Ureteral diversion
* Post - hypocapnia, pancreatic fistula/drainage
* Spironolactone, saline resuscitation
What is metabolic Alkalosis
pH > 7.4 secondary to metabolic disturbance
excess acid excretion
increased level of base (HCO3)
what is hallmarked by increased serum levels of HCO3
metabolic alkalosis
what are causes of Metabolic alkalosis
Barf (vomiting)
excessive corticosteroid action
alkali admin
rapid correction of hypercapnia, renin secreting tumor, renal artery stenosis
diuretics, diarrhea/lax abuse
suction (NG)
pt is/has been vomiting
metabolic alkalosis
pt is a diabetic
metabolic acidosis
pt is smoker/has COPD
respiratory acidosis
pt with a hx of liver disease
respiratory alkalosis
pt with recent heavy ETOH use
metabolic acidosis
pt has/had diarrhea
metabolic acidosis
pt is tachypneic
respiratory alkalosis
pt is hypotensive
metabolic acidosis
pt is post-respiratory/cardiac arrest
respiratory acidosis
What are the symptoms of metabolic acidosis
hyperventilation(Compensatory)
hypotension (reduced CO, vasodilation)
ventricular arrhythmias (electrolytes)
neurologic symptoms
what are the symptoms of metabolic alkalosis
neurologic symtpoms (paresthesias, AMS)
symptoms of hypvolemia
what are symptoms of respiratory acidosis
metabolic encephalopathy (CNS depres)
HA/Drowsiness (CNS depres)
coma
decreased CO
pulonary HTN
what are the symptoms of respiratory alkalosis
hypervent
tetany-like syndrome
paresthesias
giddiness
lightheadedness
what is the gold standard for evaluation of:
* acid-based balance
* oxygenation
* ventilation
ABG
what are the indications for ABG
critically ill
respiratory conditions
metabolic disorders
what does ABG tell us
- pH
- Partial pressure of Oxygen (PaO2, PO2)
- partial pressure of carbon dioxide (PaCO2, PCO2)
- bicarbonate (HCO3) concentration
- degree of excess or deficit of base in blood
- oxygen saturation (SaO2)
What is normal PaO2/PO2 levels
75-100 mmHg
What is normal PaCO2/PCO2
35-45 mmHg
what is normal HCO3
22-26 meg/L
what is the calculation of AG
Na+ - (Cl- + HCO3)
BMP/CMP
