Acid-base imbalances

Question 1

Respiratory Acidosis: Hypoventilation

Answer 1

Causes:
Opioids or sedations
Fluid in the lungs (impaired gas exchange)
Brain damage at the site of the respiratory center
Airway obstruction (including alveolar-capillary obstructions)
Asthma
COPD/emphysema
OSA
pH < 7.35 and CO2 >45
The lungs are retaining too much Co2
The kidneys try to compensate by excreting excess hydrogen and retaining bicarb

Question 2

Respiratory acidosis signs and symptoms

Answer 2

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Question 3

Treatment: Respiratory Acidosis

Answer 3

*Maintain airway
*Administer oxygen, may need cpap or bipap
*TCDB, positioning
*Monitor K+ levels
*If CO2 > 55, may need intubation/ventilatory support
**note that some patients with chronic respiratory acidosis may live with higher CO2 concentrations (those with pulmonary disease, sleep apnea, obesity)

Question 4

Respiratory Alkalosis: Hyperventilation

Answer 4

*pH > 7.35 and CO2 <35
*Lungs are losing too much CO2
*The kidneys compensate by excreting Bicarb and retaining Hydrogen

*Causes:
*Hyperventilation from fear/anxiety/PAIN
*Early stages of asthma and PNA
*Altitude sickness (hypoxemia)
*ASA toxicity
*Fevers

***Normal state in pregnancy

Question 5

Respiratory Alkalosis signs and symptoms

Answer 5

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Question 6

Respiratory Alkalosis: Treatment

Answer 6

*Try to assess/fix the cause
*Calming interventions
*Anxiety reduction
*Rebreathing techniques (to increase intake of CO2)
*Monitor K and Ca levels **Resp alkalosis itself is rarely life-threatening

Question 7

Metabolic Acidosis

Answer 7

*pH <7.35 and HCO3 < 22
*A kidney Problem!
*Too much hydrogen and too little bicarb
*The lungs compensate by blowing off CO2

*Causes:
*Diabetic ketoacidosis
*Acute/chronic kidney injury
*Malnutrition
*Severe diarrhea

Question 8

Metabolic acidosis signs and symptoms

Answer 8

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Question 9

Treatment: Metabolic Acidosis

Answer 9

*Correct underlying condition
*Administer IV solutions to for hydration if needed
*Administer IV sodium bicarb if needed
*O2 if necessary
*Seizure precautions
*Monitor K+ levels
*Hemodialysis if severe and kidneys failing

Question 10

Metabolic Alkalosis

Answer 10

*pH >7.45 and HCO3 > 26
*This is a kidney problem!
*Too much bicarb and too little hydrogen
*The lungs compensate by retaining CO2

*Causes:
*OD of antacids
*Excessive vomiting
*Excessive NG suctioning
*Diuretics

Question 11

metabolic alkalosis signs and symptoms

Answer 11

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Question 12

Treatment: Metabolic Alkalosis:

Answer 12

Treat the underlying cause
Control vomiting
Administer IV fluids to help remove bicarb from the kidneys
Monitor K and Ca
Replace electrolytes as needed
Monitor respirations