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PHRM 864 > Acid-Base - Kania > Flashcards

Acid-Base - Kania Flashcards

1
Q

what is a normal pH

A

7.35-7.45

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2
Q

which side of the buffer system has fast compensation?

A

the lungs!! CO2 + H20

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3
Q

Which side of the buffer system has slow compensation?

A

the kidneys
H+ and HCO3

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4
Q

What is the normal value for PaCO2

A

40 mmHg

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5
Q

What is the normal value for HCO3

A

24 MEq/L

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6
Q

where is bicarbonate reabsorbed?

A

the proximal tubule in the kidney

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7
Q

where does H+ excretion occur in the kidney?

A

in the distal tubule

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8
Q

what is the primary change in metabolic acidosis?

A

Decreased HCO2

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9
Q

what is the compensatory mechanism for metabolic acidosis?

A

decreased PaCO2

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10
Q

what is the primary change in metabolic alkalosis

A

increased HCO3

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11
Q

what is the compensatory mechanism in metabolic alkalosis

A

increased PaCO2

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12
Q

What is the primary change in respiratory acidosis?

A

Increased PaCO2

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13
Q

What is the compensatory mechanism for respiratory acidosis

A

Increased HCO3

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14
Q

What is the primary change in respiratory alkalosis

A

decreased PaCO2

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15
Q

what is the compensatory mechanism for respiratory alkalosis?

A

decreased HCO3

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15
Q

How to identify metabolic acidosis

A

low pH, low serum HCO3, and compensatory decrease in PaCO2

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16
Q

need to calculate the anion gap

A

Anion gap = Na+ - (Cl- + HCO3-)

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17
Q

what is a normal anion gap?

A

3-11

18
Q

causes of non-anion gap acidosis (loss of HCO3 replaced by Cl-)

A

diarrhea, pancreatic fistulas, biliary drainage, reduced HCO3 resorptive threshold in proximal tubule, reduced renal H+ excretion, chronic renal failure, TPN

19
Q

Anion Gap Acidosis

A

MULE PAK

19
Q

what is the dosing for bicarb

A

(0.5L/kgxIBW) x (desired HCO3 - actual HCO3)

20
Q

What does MULE PAK stand for?

A

methanol intoxication, uremia, lactic acidosis, ethylene glycol, paraldehyde ingestion, aspirin, ketoacidosis

20
Q

when anion gap acidosis is confirmed, calculate a delta gap

A

patient’s anion gap - normal anion gap

21
Q

what are the causes of anion gap metabolic acidosis

A

lactic acidosis, shock, ethanol, metformin, propylene glycol, seizures, leukemia, hepatic/renal failure, diabetes, malnutrition, rhabdomyolysis, ketoacidosis, salicylate toxicity (ASA), methanol/ethylene glycol

21
Q

What do you do with a delta gap

A

Add to the patients measured HCO3- (result should be in the normal range for HCO3-)
If HCO3 - is elevated, there is also metabolic acidosis present

22
Q

risks of bicarbonate administration

A

hypokalemia, hypocalcemia

22
Q

desired HCO3

A

12 mEq/L
give 1/3 to 1/2 of the calculated dose and monitor

23
Q

How is metabolic acidosis characterized

A

increased pH, increased HCO3-, compensatory hypoventilation resulting in increased PaCO2

24
Q

causes of metabolic alkalosis

A

loss of acid from the GI tract, administration of bicarb, contraction alkalosis

25
Q

what is saline responsive alkalosis

A

urinary chloride <10-20 mEq/L; correcting volume fixes alkalosis

26
Q

what are the causes of saline responsive alkalosis

A

diuretics, vomiting/NG suction, lactated ringers and TPNs

27
Q

causes of saline resistant alkalosis

A

increased mineralcorticoid activity, hypokalemia, bartter’s syndrome

27
Q

how is saline resistant alkalosis identified

A

urinary chloride >20

28
Q

symptoms of alkalosis

A

muscle cramps, weakness, parathesisas, aposrtural dizziness, hypoxia, confusion, coma, seizures, CV collapse, arrythmias

29
Q

treatment of saline resistant alkalosis

A

correct underlying cause; usually not urgent

30
Q

treatment of saline responsive alkalosis

A

use 1 liter NS with K supplement if needed (<4), may also use carbonic anhydrase inhibitors

31
Q

persistent metabolic alkalosis treatment

A

hydrochloric acid, ammonium chloride, arginine monohydrate

32
Q

characteristics of respiratory acidosis

A

low ph, hypercapnia >45, compensatory increase in HCO3-

33
Q

causes of respiratory acidosis

A

airway obstruction, reduced drive to breathe, PE or cardiac arrest, ALS, mech vent

34
Q

respiratory acidosis symptoms

A

SOB, dyspnea, drowsiness, HA, coma, seizures, tachycardia, arrythmias

35
Q

Treatment of respiratory acidosis

A

correct underlying cause, mech vent, may need bicarb

36
Q

characteristics of respiratory alkalosis

A

increased pH, decreased PaCO2 <40, compensatory decrease in HCO3- concentration

37
Q

cause of respiratory alkalosis

A

increased drive to breathe, mech vent, aSA intoxication

38
Q

treatment of respiratory alkalosis

A

correct the underlying cause: ventilation, sedation, paralysis

PHRM 864 (9 decks)

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