Acid Base disturbances

Question 1

what is the absolute base line for pH levels, especially when considering mixed disorders?

Answer 1

7.40

Question 2

Respiratory Acidosis Labs

Answer 2

pH-decreased
CO2-increased
bicarb- increased

Question 3

what is the compensatory mechanism from the kidneys?

Answer 3

slow increase in plasma bicarb

Question 4

what can cause RAci?

Answer 4

failure of lung to excrete CO2 from either alveolar hypoventilation leading to pulmonary CO2 retention or overproduction of CO2

Question 5

what are the primary causes of RAc

Answer 5

any disorder that reduces pulmonary function and CO2 clearance- primary pulmonary dz, neuromuscular dz (myasthenia gravis) , primary CNS, parental nutrition

Question 6

Clinical features of respiratory acidosis

Answer 6

metabolic encephalopathy- headaches and drowsiness

hypoxemia

Question 7

lab findings for R ACid

Answer 7

ph decreased, PCO2 increased

2-5 days later plasma bicarb increased

Question 8

tx for RAC

Answer 8

underlying disorder corrected

Question 9

when to intubate pt in RAc?

Answer 9

when the PCO2 greater than 60 mmHg

Question 10

Ralk?

Answer 10

decreased blood PCO2 and increased blood pH

Question 11

PP of RAl?

Answer 11

excessive elimination of CO2 from increased ventalory drive

response- kidneys will gradually eliminate plasma bicarb

Question 12

what is the most common cause of respiratory alk?

Answer 12

anxiety! (hysterical hyperventilation)

Question 13

other causes of R Alk?

Answer 13

salicylate intoxication, hypoxia, intrathoracic disorders, primary CNS dysfxn , gram neg sepicemia, liver insuffic, PREGO? bad ventilator settings

Question 14

CF of RAlk?

Answer 14

hyperventilation

breathing patter- frequent, deep, sighing respirations, to rapid deep breathing

acroparesthesias- burning of hands and feet

Question 15

what is acute alkalemia similar too?

Answer 15

hypocalemia- may produced a tetany-like syndrome

paresthesia of the extremities, chest discomfort, light-headedness, and confusion

Question 16

Lab findings of R. ALk?

Answer 16

PH increased, PCO2 decreased,

decreased in Plasma bicarb, serum chloride levels elevated- maintain electroneutrality

Question 17

Treatment of RAL

Answer 17

light sedation- rebreathing techniques have fallen out of favor bc additional anxiety

Question 18

when is CO2 breathing mixtures of controlled ventilation requried?

Answer 18

when pH > 7.6

Question 19

Metabolic Acidosis?

Answer 19

elevation in H ion due to loss of bicarb or addition of H ions to serum

Question 20

what is the immediate response of metabolic acidosis?

Answer 20

increase in respiration

Question 21

what can cause an increase in Blood pH? and an increased anion gap?

Answer 21

lactic acidosis, DKA, starvation ketosis, ethylene glycol, methanol or salicylate intoxication

H ions may also be retained in renal tubular acidosis, renal insufficiency and adrenal insuficiency

Question 22

what are conditions that cause M Ac but with normal AG?

Answer 22

Diarrhea, pancreatic or biliary drainage, and uretral diversion

Question 23

CF of Met AC

Answer 23

hyperventilation- stimulation of respiratory drive to blow off CO2

• ventricular arrhythmias
• lethargy to frank coma

Question 24

what is winter’s formula?

Answer 24

PCO2= {1.5 X HCO3-] + 8 +/- 2

calculation of the expected PCO2 compensation

Question 25

Lab Studies for MAc

Answer 25

** bicarb follows the pH in metabolic disorders make sure to calculate the AG

Question 26

What is hyperchloremic Metabolic acidosis?

Answer 26

Cl ion increased as bicarb decreased to maintain electroneutrality (normal AG acidosis)

Question 27

common cuases of Normal AG renal tubular acidosis?

Answer 27

-either kidney failing to reabsorb bicarb or secrete acid USED CARP

Question 28

what does USED CARP stand for?

Answer 28

Ureteroenterostomy Small bowel fistual Endocrinopathies/extra Cl Diarrhea Carbonic anhydrase inhibitors Ammonium chloride Renal tubular acidosis Pancreatic Fistula

Question 29

What must be taken into considerations when calculating AG?

Answer 29

negative charge of albumin can impact overall AG -hypoalbumiemia present: for each 1.0 g/dL decrease in serum albumin, the AD should be increasd by 2.5

Question 30

how is AG calculated?

Answer 30

Na - [HCO3- + Cl-]; normal is 8+/- 4

Question 31

what may cause elevated AG Acidosis?

Answer 31

- lactic acidosis - ketoacidosis - toxins/drugs - kidney failure

Question 32

what does CAT MUD PILES stand for?

Answer 32

``` Carbon Monoxide/Cyanide Alcoholic ketoacidosis Toluene methanol Uremia DKA Paraldehyde Infection/Iron/Isoniazide Lactic Acidosis Ethylene glycol (antifreeze) Salicylates (ASA) ```

Question 33

tx of MAc

Answer 33

remove primary cuase Insulin therapy and volume repletion for DKA

Question 34

when do you use Bicarb tx for MAc?

Answer 34

when pH less than 7.20

Question 35

Metabolic Alkalosis?

Answer 35

increase in surm bicarb w/ no change in PCO2 pH > 7.42

Question 36

PP of m.alk?

Answer 36

kidney fails to excrete the excess bicarb CO2 compensation= (0.7 X HCO3-) + 20 +/- 2

Question 37

what can cause M. Alk?

Answer 37

Vomiting, addition of bicarb (hyperalimentation therapy PPN) or Diarrhea (caused by loss of Cl) -V -NG tube suctioning Villious adenoma Chloride D diuretics hypercalcemia milk-alki syndrome mineralocorticoid excess Bartter and Gitelman syndromes Cl/K depletions of excessive steroids

Question 38

CF of Met Alk?

Answer 38

neuroligic abnormlaties -low ionized Calcium: paresthesias, carpopedal spasm, light headedness - stupor, coma - sx from volume depletion: wksn, muscle cramps, postural dizzy - sx from K depletion: polyuria, polydipsia, weakness

Question 39

what does urine Chloride concentrations tell you in a met. alk pt?

Answer 39

hypovolemic hypochloremic patients w/ decreased urine Cl (< 20) volume expanded pts- mineralocorticoid excess who have urine chloride concentrations > 30

Question 40

what are some interventions to help met. alk pts?

Answer 40

increase renal excretion of bicarb depends on whether or not pt is chloride responsive

Question 41

what are some Chloride responsive condtions of Met. Alk? what is the tx?

Answer 41

gastric fluid loss, diuretic therapy tx- NaCl

Question 42

Chloride resistant conditions and tx?

Answer 42

mineralcorticoid excess: removal of adrenal ademona spironolactone- aldosterone antagonist