Arterial blood gases section 4

Question 1

Respiratory acidosis

pulmonary dysfunction

Answer 1

Airway obstruction, chronic obstructive pulmonary disease, status asthmaticus

Question 2

Respiratory acidosis

Muscular dysfunction

Answer 2

Guillain-barre syndrome, myasthenia gravis

Question 3

Respiratory acidosis

Neurological dysfunction

Answer 3

Central nervous system depression, sedatives, brain injury, CNS depressants (important)

Question 4

therapy for respiratory acidosis

Answer 4

treat underlying cause
avoid exacerbating agents (CNS depressants or sedative bc it may make it worse)
alkali therapy in severe cases

Question 5

metabolic acidosis, causes

high anion gap

Answer 5

MUDSLIDES
methanol
uremia
diabetic ketoacidosis 
propylene glycol
iron
lactate
-metformin
ethylene glycol
salicylates

Question 6

metabolic acidosis, causes

non anion gap (hyperchloremic)

Answer 6

diarrhea, normal saline, carbonic anhydrase inhibitors, deficiency of mineralocorticoid

Question 7

metabolic acidosis, therapy

Answer 7

treat underlying cause
avoid exacerbating agents (metformin, salicylates, carbonic anhydrase inhibitors)
alkali therapy in severe cases or based on underlying cause

Question 8

alkali therapy

Answer 8

sodium bicarbonate (can increase co2)
sodium acetate
sodium citrate
sodium lactate
tromethamine (THAM) - (used rarely, only when sodium bicarbonate is on shortage, buffering system)

Question 9

difference bw na hco3- and tham

Answer 9

sodium bicarbonate has longer lasting effect
sodium bicarbonate decreased serum potassium and increased serum sodium (THAM had opposite effect, important in patients with hyponatremia)

Question 10

respiratory alkalosis, cause

Answer 10

stimulation of hyperventilation
ex: anxiety, fear, pain, pregnancy, lung disease, brain tumor, stroke. aspirin, caffeine, theophylline
excreting co2

Question 11

respiratory alkalosis, therapy

Answer 11

treat underlying cause
avoid exacerbating agents
consider rebreathing in symptomatic cases (paper bag)

Question 12

metabolic alkalosis, cause

Answer 12

vomiting (loss of chloride), gastric aspiration (hospital induced), loss of K, mineralocorticoid excess, diuretics, laxatives, corticosteroids, licorice, milk-alkali syndrome, penicillin, exchange of resin and antacid administration

Question 13

metabolic alkalosis, therapy

Answer 13

treat underlying cause
avoid exacerbating agents
replace chloride and potassium
consider hydrochloric acid in severe cases