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Pharm 1 > Acid & Bases 2 > Flashcards

Acid & Bases 2 Flashcards

1
Q

Arterial Blood Gases Test (ABGs)

A

-sample from an artery (usually the radial artery)
-not a routine test (acute)
-more painful than a venous sample
-and RN requires special training

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2
Q

What do AGBs Measure?

A

Ph, paO2 (partial pressure), paCO2, HCO3

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3
Q

When are AGBs used?

A

-Reserved for people who have acute illnesses and are unstable (sepsis/acute respiratory distress syndrome)
-diabetic ketoacidosis, acute exacerbation of chronic pulmonary disease
-sometimes used to qualify a patient for certain treatments like home oxygen

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4
Q

PaO2

A

-Normal values: 80-100mmHg
-Not the same as O2 saturation
-O2 levels do not factor into your assessment for acid-base imbalances but is an accurate measurement of how much oxygen is in the arterial blood
-A low paO2 is reflective of hypoxemia
-You can see amounts over 100 when a pt is getting supplemental oxygen

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5
Q

PaCO2

A

-Normal values: 35-45mmHg
-Measures the amount of CO2 gas in the blood
-Helps you ability to analyze ABG results if you label this as “respiratory acid”

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6
Q

HCO3 (bicarbonate)

A

-Normal Values: 22-26mmol/L
-Is the metabolic base

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7
Q

Venous Blood Gases (VBG)

A

-Can also be preformed
-Normal values different the ABG
-The average VBG pH is 0.03-0.04 less than the ABG pH values
-CO2 values are difficult to measure on VBGs (not accurate)
-VBGs are useful in ongoing monitoring and response to treatment for metabolic disorders but are not useful if the pt has a resp acid-base disorder

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8
Q

Arterial Lines

A

-Only used in critical care setting (step down, ED, ICU)
-Used to continuously monitor BP
-Used to easily collect blood
-CANNOT be used for medication infusions
-RNs require additional training
-Carry many risks for complications
-Not like CVADs

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9
Q

Acid-Base Imbalances

A

-When an imbalance occurs, it means the buffering systems have failed (disease/injury cannot be corrected with buffering alone)
-While acidosis/alkalosis disrupts cellular function and needs to be addressed, the primary focus is identifying and treating the CAUSE of the imbalance
-Can either be metabolic or respiratory in nature

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10
Q

Abnormal arterial blood gas findings are simply evidence of…

A

An underlying pathology

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11
Q

Causes of an imbalance: Metabolic

A

-Too little or too much bicarbonate

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12
Q

Causes of an imbalance: Respiratory

A

-Too little or too much carbon dioxide

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13
Q

Once an imbalance has occurred..

A

The OPPOSITE system will attempt to fix the problem (compensate)

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14
Q

If the cause of the imbalance is respiratory …

A

-Then the metabolic system (bicarbonate) will compensate

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15
Q

If the cause of the imbalance will s metabolic ..

A

The respiratory system (paCO2) will compensate

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16
Q

What the body cares about

A

-ultimately the imbalance is not resolved until the source of the problem is addressed, but in short term, all the body cares about is getting the pH between 7.35-7.45

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17
Q

Respiratory Acidosis

A

-Seen in patients who are RETAINING carbon dioxide (acid)
-This means they are having troubles breathing out CO2
-This means the CO2 (acid) is remaining in their blood =acidosis

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18
Q

Examples of causes of Respiratory Acidosis

A

-COPD (CO2 trapped in alveoli)
-Opioid OD (hypoventilating)

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19
Q

Respiratory Alkalosis

A

-Seen in patients who are losing too much carbon dioxide (acid)
-This means they are “breathing out” too much CO2
-This means CO2 is no longer in the blood = alkalosis

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20
Q

Examples of Causes of Respiratory Alkalosis

A

-Pt in pain or panicking (hyperventilating)

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21
Q

Respiratory imbalances occur when..

A

-Something (disease, injury, drugs) affect the lungs ability to function normally (and when buffering system failure)
-CO2 is an acid so retaining it will result in acidosis and blowing too much out will result in alkalosis

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22
Q

Labelling Resp vs Metabolic

A

-Labelling paCO2 as the respiratory ACID and HCO3 bicarb as the metabolic BASE is the best way rot apply acid base concepts

23
Q

Respiratory Imbalances pH (resp acidosis/alkalosis)

A

pH respiratory acidosis: decrease
pH respiratory alkalosis: increase

24
Q

Respiratory imbalances: PaCO2 (resp acidosis/alkalosis)

A

PaCO2 respiratory acidosis: Increase
PaCO2 respiratory alkalosis: decrease

25
Q

Respiratory Imbalances: HCO3 (resp acidosis/alkalosis)

A

HCO3 Respiratory acidosis: Kidbeys compensation increase
HCO3 respiratory Alkalosis: Kidneys compensation decrease

26
Q

Respiratory Acidosis Process

A

-If occuring, means there is an inability to move CO2 out of the body through the alveoli
-If pt not exhaling the CO2 = hypoventilation
-The excess in CO2 will cause an increase in carbonic acid present in the blood
-Since carbonic acid already has as many H+ as it can compensate, the kidneys increase the excretion of H+ and the reabsorption of bicarb to try to increase pH
-means in acute short term elevations of PaCO2 you will not see any elevation of HCO3 in response
-if elevation of HCO3 this tells you elevation of paCO2 (resp acid) has been present for at least 48 hours
-kidneys try ti offset resp acidosis by creating metabolic alkalosis

27
Q

Respiratory Alkalosis Process

A

-Mean lungs have expelled too much CO2 (hyperventilation)
-Results in an accelerated loss of carbonic acid
-If pt exhaling too rapidly, leads to a deficit of carbonic acid in the blood, increasing the pH of the blood
-To compensate kidneys will hold onto H+ ions and increase the excretion of bicarb to compensate for lack of respiratory acid
-Kidneys are trying to create a metabolic acidosis to offset resp alkalosis

28
Q

Most causes of resp alkalosis are due to …

A

-Anxiety or pain responses, increasing RR
-Once underlying problem is resolved and RR decreases, the pH will normalize = most self limiting and usually least harmful and will not usually see chronic conditions that cause ongoing respiratory alkalosis

29
Q

Metabolic Acidosis

A

-By far the most common metabolic imbalance
-Have multiple causes
-Seen in patients who produce or retain too much H+ = acidosis
-Seen in patients losing too much bicarb

30
Q

Metabolic Acidosis: Retaining/producing too much H+ examples

A

-Eg: diabetic ketoacidosis (DKA), sepsis, acute kidney injury (AKI)

31
Q

Metabolic Acidosis: Patient losing too much bicarb examples

A

Eg: Diarrhea (lower GI tract is full of bicarb)

32
Q

Metabolic Alkalosis

A

-Seen in patients who are loosing too much H+ =alkalosis
-Seen in patients who are hypokalemic (low potassium)

33
Q

Metabolic Alkalosis: Loosing to much H+ examples

A

-Eg: Vomiting (upper GI tract full of H+)

34
Q

Metabolic Alkalosis: pt who are hypokalemic examples

A
  • pt taking too much diuretic
35
Q

Metabolic Imbalance pH: metabolic acidosis

A

-ph increase

36
Q

Metabolic imbalance ph: metabolic alkalosis

A

ph increase

37
Q

Metabolic imbalance PaCO2 (lungs): metabolic acidosis

A

Lungs compensate: decrease

38
Q

Metabolic imbalance PaCO2 (lungs): Metabolic alkalosis

A

Lungs compensate: increase

39
Q

Metabolic imbalance HCO3 (kidneys): Metabolic acidosis

A

Kidneys HCO3 decrease

40
Q

Metabolic imbalance HCO3 (kidneys): Metabolic Alkalosis

A

Kidneys HCO3 increase

41
Q

Kussmaul Respiration

A

-When there is metabolic acidosis there is an excess of carbonic acid and a deficit of bicarb
-Resp system will IMMEDIATELY compensate by exhaling more CO2
-The rapid deep breathing that accelerates exhalation of CO2 is triggered by central chemoreceptors sensing the higher CO2 and lower pH content in the blood
-happens immediately
-Resp system trying to create a respiratory alkalosis to offset metabolic acidosis

42
Q

Metabolic Alkalosis and Resp compensation

A

-The elevated pH triggers a decrease in ventilation via slow, shallow respiration’s in an attempt to retain PaCO2
-Resp system trying to create a respiratory acidosis to offset the metabolic alkalosis

43
Q

Venous Blood Test

A

-Venous blood sent to biochemistry can tell us a little about METABOLIC imbalance (when you don’t have an ABG)
-It cannot tell you anything about RESPIRATORY imbalances

44
Q

Other Blood Tests

A

-2 Plasma Tests help to inform acid base balance
-1. Total CO2
-2. Anion Gap

45
Q

Total CO2 Test Normal Values

A

22-30 mmol/L (TCO2)

46
Q

What Does Total CO2 Measure?

A

-is a measurement of the amount of BICARB (HCO3)

47
Q

Total CO2 Test

A

-Plasma test (cannot measure gases in plasma)
-Because so much CO2 is hidden in the bicarb, this measurement is an excellent estimator of serum bicarbonate
-Use processes in the lab to separate CO2 from the bicarb so technically they are measuring CO2

48
Q

TCO2 Low Levels

A

-Low levels of TCO2 (bicarb) result from either metabolic acidosis or as a compensation for respiratory alkalosis
-However if TCO2 is VERY low (below 10mmol) we can assume this is due to metabolic cause because compensation for respiratory alkalosis wouldn’t drive the bicarbonate that low

49
Q

High TCO2

A

-Means there is metabolic alkalosis OR this could be compensation for chronic hypercapnia like in COPD patients

50
Q

Anion Gap Test

A

-NOT relevant to respiratory disorders
-Only helps us know what contributed to a known METABOLIC acidosis
-Automatically reported with electrolytes
-If more of these unmeasured anions are present than normal, you have an elevated anion Gap which supports metabolic acidosis due to excess production of acids

51
Q

What causes an elevated anion Gap?

A

-caused by conditions where excess acids have been ADDED to the plasma
Eg: DKA, AKI, lactic acidosis
-= Elevated AG = Acids gained (AG)

52
Q

Non AG Acidosis results form …

A

A LOSS of bicarbonate
-the most common cause is prolonged diarrhea
-biliary, pancreatic, and duodenal secretions are alkaline and neutralize the acidity of gastric secretions so when they are lost, the balance shifts toward acidity

53
Q

When you don’t have an ABG you can look at..

A

TCO2 and AG on a venous blood test to get clues about a patients metabolic imbalances

Pharm 1 (4 decks)

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