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pathophysiology > acidosis and alkalosis stuff > Flashcards

acidosis and alkalosis stuff Flashcards

1
Q

What are acid-base imbalances?

A

Changes in the concentration of hydrogen ions (H⁺) in the blood, evaluated with an arterial or venous blood gas.

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2
Q

What are the 4 main types of acid-base imbalances?

A
  1. Metabolic Acidosis (LOW pH, LOW bicarbonate) 2. Metabolic Alkalosis (HIGH pH, HIGH bicarbonate) 3. Respiratory Acidosis (LOW pH, HIGH paCO2) 4. Respiratory Alkalosis (HIGH pH, LOW paCO2)
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3
Q

How do metabolic and respiratory acid-base imbalances behave in relation to pH and bicarbonate or paCO2?

A

Metabolic imbalances go in the same direction (pH and bicarbonate change together), whereas respiratory imbalances are inverse (pH and paCO2 change oppositely).

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4
Q

What is acidosis?

A

A systemic increase in H⁺ or a loss of base, resulting in a low blood pH (<7.35).

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5
Q

What is alkalosis?

A

A systemic decrease in H⁺ or an excess of base, resulting in a high blood pH (>7.45).

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6
Q

What are the characteristics of metabolic acidosis?

A

LOW pH (<7.35), LOW bicarbonate (<22 mEq/L). Extra acid or not enough base.

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7
Q

What mechanisms cause metabolic acidosis?

A

Non-carbonic acids increase, loss of bicarbonate from extracellular fluid, or failure of the pancreas to secrete bicarbonate or kidneys to reabsorb it.

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8
Q

What are the factors associated with metabolic acidosis?

A

Poor blood perfusion, blood loss, hypoxemia, renal failure, diabetic ketoacidosis (DKA), starvation.

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9
Q

What are the manifestations of metabolic acidosis?

A

Kussmaul’s respirations (rapid breathing), lethargy to coma, oliguria, headache, nausea, vomiting, diarrhea, abdominal discomfort.

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10
Q

What is the diagnosis of metabolic acidosis?

A

Based on history, physical exam, and arterial blood gas (ABG) showing low pH and low bicarbonate.

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11
Q

What are the characteristics of metabolic alkalosis?

A

HIGH pH (>7.45), HIGH bicarbonate. Not enough acid, too much base.

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12
Q

What mechanisms cause metabolic alkalosis?

A

Excessive loss of non-carbonic acids; renal compensation fails due to loss of chloride, leading to bicarbonate retention.

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13
Q

What are the factors associated with metabolic alkalosis?

A

Excessive vomiting, continued NG suctioning, hyperaldosteronism, diuretic use (greater excretion of sodium, potassium, and chloride).

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14
Q

What are the manifestations of metabolic alkalosis?

A

Muscular weakness, cramps, hyperactive reflexes, tetany, confusion, convulsions, seizures, atrial tachycardia.

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15
Q

What is the diagnosis of metabolic alkalosis?

A

Based on history, physical exam, and arterial blood gas (ABG) showing high pH and high bicarbonate.

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16
Q

What are the characteristics of respiratory alkalosis?

A

HIGH pH (>7.45), LOW paCO2 (<35 mmHg). Caused by blowing off too much CO2.

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17
Q

What mechanisms cause respiratory alkalosis?

A

Alveolar hyperventilation leads to hypocapnia (low CO2), decreasing carbonic acid.

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18
Q

What are the factors associated with respiratory alkalosis?

A

Hypoxemia (pulmonary disease, heart failure, high altitude), anxiety, fever, overventilation, metabolic or respiratory acidosis.

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19
Q

What are the manifestations of respiratory alkalosis?

A

Rapid respirations, accessory muscle use, dizziness, confusion, paresthesias, carpopedal spasm, convulsions, coma.

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20
Q

What is the diagnosis of respiratory alkalosis?

A

Based on history, physical exam, and arterial blood gas (ABG) showing high pH and low paCO2.

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21
Q

What are the characteristics of respiratory acidosis?

A

LOW pH (<7.35), HIGH paCO2 (>45 mmHg). Caused by not breathing fast enough.

22
Q

What mechanisms cause respiratory acidosis?

A

Alveolar hypoventilation results in hypercapnia (excess CO2), increasing carbonic acid.

23
Q

What are the factors associated with respiratory acidosis?

A

Depression of the respiratory center (brainstem), opioids, head or spinal injury, paralysis of respiratory muscles, chest wall disorders, lung disorders (e.g., pneumonia, COPD).

24
Q

What are the manifestations of respiratory acidosis?

A

Bradypnea, small breaths, lethargy, disorientation, dyspnea, headache, blurred vision, restlessness, muscle twitching, tremors, convulsions, coma.

25
Q

What is the diagnosis of respiratory acidosis?

A

Based on history, physical exam, and arterial blood gas (ABG) showing low pH and high paCO2.

26
Q

Why might a patient with respiratory distress start with respiratory alkalosis and progress to respiratory acidosis?

A

Initially, they blow off too much CO2, causing alkalosis, but muscle fatigue leads to slower breathing, causing them to retain CO2, leading to acidosis.

27
Q

What is the first question to ask when interpreting an ABG?

A

Is the pH low (acidosis), high (alkalosis), or within the normal range?

28
Q

What does a low pH indicate?

A

Acidosis.

29
Q

What does a high pH indicate?

A

Alkalosis.

30
Q

If the pH is low, how can you determine if it’s metabolic or respiratory?

A

If the pH is low, check if it’s metabolic (low HCO₃⁻) or respiratory (high paCO₂).

31
Q

If the pH is high, how can you determine if it’s metabolic or respiratory?

A

If the pH is high, check if it’s metabolic (high HCO₃⁻) or respiratory (low paCO₂).

32
Q

What should you consider if the pH is within the normal range?

A

Determine if the blood gas is normal or if compensation is occurring.

33
Q

What are the types of ABG compensation?

A
  1. Normal 2. Uncompensated 3. Partially compensated 4. Fully compensated
34
Q

What is a normal ABG?

A

All values (pH, paCO₂, HCO₃⁻) are within the normal range.

35
Q

What is an uncompensated ABG?

A

The pH is not normal, and there is no evidence of compensation.

36
Q

What is a partially compensated ABG?

A

The pH is not normal, but there’s evidence that the body is trying to correct the imbalance.

37
Q

What is a fully compensated ABG?

A

The pH is normal, but other values are abnormal, indicating the body has corrected the imbalance.

38
Q

How do you recognize compensation in metabolic acidosis?

A

The paCO₂ levels will be <35 mmHg.

39
Q

How do you recognize compensation in metabolic alkalosis?

A

The paCO₂ levels will be >45 mmHg.

40
Q

How do you recognize compensation in respiratory acidosis?

A

The bicarbonate (HCO₃⁻) levels will be >26 mEq/L.

41
Q

How do you recognize compensation in respiratory alkalosis?

A

The bicarbonate (HCO₃⁻) levels will be <22 mEq/L.

42
Q

What final question should you ask when interpreting an ABG?

A

Is the patient hypoxic?

43
Q

What are the normal ranges for pH, paCO₂, paO₂, HCO₃⁻, and O₂ saturation?

A

pH: 7.35-7.45 / paCO₂: 35-45 mmHg / paO₂: 80-100 mmHg / HCO₃⁻: 22-26 mEq/L / O₂ sat: 90-100%

44
Q

Interpret the ABG: pH 7.28 / paCO₂ 36 / paO₂ 91 / HCO₃⁻ 17 / SpO₂ 96%

A

Uncompensated Metabolic Acidosis

45
Q

What indicates metabolic acidosis in the ABG: pH 7.28 / paCO₂ 36 / paO₂ 91 / HCO₃⁻ 17 / SpO₂ 96%?

A

The pH is low (7.28) and HCO₃⁻ is low (17), indicating metabolic acidosis. paCO₂ is normal, so no compensation.

46
Q

Interpret the ABG: pH 7.39 / paCO₂ 42 / paO₂ 88 / HCO₃⁻ 24 / SpO₂ 95%

A

Normal ABG

47
Q

What indicates a normal ABG: pH 7.39 / paCO₂ 42 / paO₂ 88 / HCO₃⁻ 24 / SpO₂ 95%?

A

All values fall within normal ranges, so it is a normal ABG.

48
Q

Interpret the ABG: pH 7.45 / paCO₂ 47 / paO₂ 62 / HCO₃⁻ 34 / SpO₂ 89%

A

Compensated Metabolic Alkalosis with Hypoxia

49
Q

What indicates compensated metabolic alkalosis in the ABG: pH 7.45 / paCO₂ 47 / paO₂ 62 / HCO₃⁻ 34 / SpO₂ 89%?

A

The pH is normal but at the higher end (7.45), HCO₃⁻ is elevated (34), and paCO₂ is elevated (47), indicating compensation.

50
Q

What additional issue is indicated in the ABG: pH 7.45 / paCO₂ 47 / paO₂ 62 / HCO₃⁻ 34 / SpO₂ 89%?

A

Hypoxia is indicated by the low paO₂ (62) and low SpO₂ (89%).

pathophysiology (56 decks)

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