Acid base final exam Flashcards
acidodic pH
less than 7.35
alkalotic pH
7.45
AE of acidemia
-decreased CO output
-insulin resistance
-hyperkalemia
-hyperventilation
AE of alkalemia
-decreased electrolytes
-decrease central blood flow
where is bicarb primarily reabsorbed
proximal tubule
bicarb reabsorption moa
-filtered bicarb combines with secreted Hydrogen
-water and co2 created
-water and co2 reabsorbed
-they disassociate and bicarb is reabsorbed back into the body
bicarb generation/H+ excretion moa
-ammoniagenesis where hydrogen is excreted and forms NH4, then bicarb is generated
metabolic acidosis changes
decreased bicarb
lungs faster/decreased CO2
metabolic alkalosis changes
increased bicarb
lungs slower/increased CO2
respiratory acidosis changes
increased CO2
kidneys increase bicarb
respiratory alkalosis changes
decreased CO2
kidneys decrease bicarb
what are the two kinds of metabolic acidosis
anion gap
non anion gap
how to calculate anion gap
Na - (Cl + bicarb)
normal anion gap
3-11
high anion gap
above 11
what is non-anion gap acidosis
loss of plasm bicarb replaced by Cl
causes of non-anion gap
GI bicarb loss
Renal bicarb loss
Acid & chloride administration
reduced renal hydrogen excretion
what is anion gap acidosis
loss of plasma bicarb replaced w/ ion other than Cl
causes of anion gap
MUDPILES
how to confirm mixed disorders
calculate delta gap then add it to patients bicarb
what is MUDPILES
Methanol intox
Uremia
DKA
Poisoning/propylene glycol
Intoxicated/Infection
Lactic Acidosis
Ethylene Glycol
Salicylate/Sepsis
How to treat anion gap acidosis
address underlying cause
consider bicarb therapy
when to do acute bicarb therapy
pH less than 7.1, hyperkalemia
how to dose acute bicarb
0.5 L/kg x IBW x (12 - actual bicarb) then give 1/2-1/3 of this
causes of metabolic alkalosis
loss of acid from GI tract/urine
giving bicarb precursor
losing Cl rich of bicarb poor fluid
what are the two types of metabolic alkalosis
saline responsive or resistant
what causes saline responsive metabolic alkalosis
diuretics
vomiting and NG suction
exogenous bicarb admin
how to treat saline responsive alkalosis
fluids and potassium supplements
carbonic anhydrase inhibitors
saline resistant causes
increased mineralocorticoid activity
hypokalemia
renal tubular chloride wasting
saline resistant treatment
correct hypokalemia w/ potassium sparing diuretic or supplementation
decrease or change steroid
spironolactone
correct hyperaldosteronism
