Acid Base Imbalance Flashcards

1
Q

Acid-Base Balance of 3:

A

Want to have a balance of the following three things:

  • pH: % of hydrogen ions in a solution as well as acids and bases
  • acids: give up or donate H+ (i.e. carbonic acid H2CO3)
  • acids are continually produced during normal metabolism
  • bases: accept H ions (i.e. bicarbonate (HCO3)
  • bases neutralize and promote excretion fo those acids to maintain pH balance
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2
Q

Acidosis:

A

pH < 7.35

increased H+ concentration = acidity

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3
Q

Alkalosis Range:

A

pH > 7.45

decreased H+ concentration = alkalinity

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4
Q

Acid Base Imbalance: Causes

A
DM
Cancer
COPD, tissue hypoxia
Renal disease
Trauma
medications (diuretics, steroids, TPN)
Prolonged vomiting, diarrhea, GI suction, malnutrition
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5
Q

Regulation of Acid-Base Balance: 1

A

Buffers:
fastest but not long action
primary regulators - bicarbonate, phosphate, and proteins (these chemicals bind to and neutralize acid need intact renal and respiratory systems to work efficiently

all body fluids contain buffers. When you look at ECF, an in crease in H+ ions may change hydrogen for potassium

  • acidosis = elevated K
  • alkalosis = lower K

Carbonic acid and bicarbonate: buffer blood and IF
Phosphates: reach with acids and bases to form compounds that alter pH
Proteins: inside and outside cells (intra and extra cellular) bind with acids and bases to alter pH

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6
Q

Regulation of Acid-Base Balance: 2

A

Respiratory System:
responds in minutes (kicks in after buffer system has kicked in)
max effect seen in a couple hours
excrete CO2 and H2O (biproducts of cellular metabolism)
increased respirations (hyperventilation): decreases plasma CO2 (less carbonic acid and less H+ ions)
decreased respirations (hypoventilation): increases plasma CO2 (increased carbonic acid and increased H+ ions)

Respiratory system must be intact to work efficiently
*if respiratory condition is cause of acid/base imbalance, it cannot regulate the pH. Cannot be the solution to the problem if it is the problem.

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7
Q

Regulation of Acid-Base Balance: 3

A

Renal System:
responds in 2-3 days but lasts longer than respiratory and buffer
excrete acid in urine
-kidneys will excrete or reabsorb H+ ions or bicarbonate
-test pH of urine which tells us how kidneys are responding to change in body pH

Renal system must be intact to be efficient.
*if renal problem is cause of imbalance, it cannot regulate pH and cannot be the solution to the problem if it’s causing the problem.

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8
Q

Symptoms of Respiratory Acidosis

A
hyperventilation leading to hypoxia
decreased BP with vasodilation
dyspnea
HA
Hyperkalemia
Drowsiness, dizziness, disorientation
muscle weakness hyperreflexia
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9
Q

Respiratory Acidosis: Causes

A

Decreased respiratory stimuli (anesthesia, drug OD)
COPD
Pneumonia
Atelectasis

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10
Q

Symptoms of Respiratory Alkalosis

A
Hyperventilations
Seizures
Tachycardia
Hypokalemia
Numbness & tingling of extremities
Lethargy and confusion
N/V

Need to aggressively treat b/c symptoms can be fatal or lead to severe consequences

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11
Q

Respiratory Alkalosis: Causes

A

Hyperventilation (Anxiety, PE, Fear)

Mechanical Ventilation

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12
Q

Metabolic Acidosis: Symptoms

A
HA
Decreased BP
Hyperkalemia
Muscle twitching
warm, flushed skin
N/V
decreased muscle tone, decreased reflexes
Kussmaul respirations
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13
Q

Metabolic Acidosis: Causes

A

Increased H+ production (DKA, hyper-metabolism)
Decreased H+ elimination (renal failure)
Decreased HCO3 production (dehydration, liver failure)
Increased HCO3 elimination (diarrhea, fistulas)

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14
Q

Metabolic Alkalosis: Symptoms

A
Restlessness followed by lethargy
Dysrhythmias (tachycardia)
compensatory hypoventilation
Confusion (decreased LOC, dizzy, irritable)
N/V
Diarrhea
Hypokalemia
Tremors, muscle cramps, tingling of fingers and toes
Hypokalemia
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15
Q

Acid Base Balance ABG Normal Values

A

pH: 7.35-7.45 (buffers)

PaCO2: 35-45 mmHg (respiratory system)

HCO3: 22-26 mEq/L (renal)

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16
Q

How ABG is drawn:

A

usually radial artery or femoral artery
can do continuous through intra-arterial catheter

before doing a radial stick you need to make sure the ulnar artery is patent (b/c you don’t want to have zero blood flow to extremity)
*do this via allen’s test

sample must be placed on ice and taken to the lab immediately