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RC Test 2 > B4.038 Acid Base Balance > Flashcards

B4.038 Acid Base Balance Flashcards

1
Q

what is an acid base disorder

A

change in the normal value of extracellular pH that may result when renal or respiratory function is abnormal or when and acid or base load overwhelms excretory capacity

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2
Q

what do you get from an ABG?

A

pH
pCO2
PO2

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3
Q

what 2 molecules give indication of acid base disorder

A

CO2

HCO3-

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4
Q

normal pH

A

7.35-7.45

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5
Q

normal pCO2

A

36-44

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6
Q

normal HCO3-

A

22-26

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7
Q

acidosis

A

process that increases [H+] by increasing PCO2 or reducing [HCO3-]

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8
Q

alkalosis

A

process that reduces [H+] by reducing PCO2 or by increasing [HCO3-]

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9
Q

what is a mixed acid base disorder

A

more than one disorder present
pH may be normal or abnormal
if abnormal trends toward the dominant disorder

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10
Q

what systems can provide compensation for acid base disorders

A

renal
respiratory
will not return pH to normal, just trend it the right way

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11
Q

what is a metabolic disorder

A

primary disturbance of blood [HCO3-]
metabolic acidosis- too little bicarb
metabolic alkalosis- too much bicarb

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12
Q

what are the 2 types of metabolic acidosis

A

anion gap

non anion gap

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13
Q

what are compensatory mechanisms for metabolic disorders

A

via respiration

changes in ventilation mediated by chemoreceptors in carotid body and lower brainstem

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14
Q

definition of metabolic alkalosis

A

HCO3- retention

HCO3- produced more than excreted

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15
Q

sources of metabolic alkalosis

A 
nasogastric suctioning
vomiting
diuretic therapy
hyperaldosteronism (addisons)
cushing syndrome (acth excess)
exogenous steroids
licorice ingestion
alkali ingestion
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16
Q

definition of metabolic acidosis

A

HCO3- depletion
anion gap: HCO3- used as a buffer for acid
nonunion gap: lost through urine or bowel

17
Q

sources of anion gap metabolic acidosis

A 
methanol
uremia (acute renal failure)
DKA
paraldehyde
INH/iron
lactic acidosis (sepsis)
ethylene glycol
salicylates
18
Q

sources of non anion gap metabolic acidosis

A 
hyperaimentation
acetazolamide and other carbonic anhydrase inhibitors
renal tubular acidosis
diarrhea
ureteroenteric fistula
pancreaticoduodenal fistula
19
Q

what is winters formula

A

predicts expected pCO2 for any given HCO3- level

expected pCO2=(1.5*[HCO3-])+8 (plus or minus 2)

20
Q

if pCO2 is above expected w winters…

A

secondary resp acidosis

21
Q

if pCO2 is below expected w winters

A

secondary resp alkalosis

22
Q

what is a respiratory disorder

A

primary alteration in the pCO2

regulated through alveolar ventilation

23
Q

definition of respiratory acidosis

A

CO2 retention

decreased alveolar ventilation

24
Q

causes of respiratory acidosis

A 
CNS depression, sedatives
neuromuscular disorders
thoracic cage limitations
acute obstruction
chronic obstruction
ventilator malfunction
25
Q

definition of respiratory alkalosis

A

CO2 depletion

increased alveolar ventilation

26
Q

causes of respiratory alkalosis

A 
anxiety
CNS disorders
salicylates, analeptics
fever, sepsis
pregnancy
liver insufficiency
hyperthyroidism
27
Q

basic steps of acid base problems

A
  1. look at pH
  2. respiratory or metabolic?
  3. if respiratory, acute or chronic?
  4. if metabolic acidosis, is resp system compensating? (winters)
  5. anion gap?
  6. delta gap?
28
Q

acute respiratory acidosis

A

increase in pCO2 shifts equilibrium to increase HCO3, this occurs immediately

29
Q

acute respiratory acidosis equations

A

pH=7.4-0.008(pCO2-40)

HCO3=24+0.1(pCO2-40)

30
Q

chronic respiratory acidosis

A

kidneys retain HCO3 which takes a few days to fully occur

31
Q

chronic respiratory acidosis equations

A

pH=7.4-0.003(pCO2-40)

HCO3=24+0.4(pCO2-40)

32
Q

anion gap equation

A 
gap = [Na] - ([Cl]+[HCO3])
normal = 12
33
Q

when do you check delta gap?

A

if there is an anion gap metabolic acidosis present

34
Q

what is the delta gap equation

A

corrected HCO3 = measured HCO3 + (anion gap-12)

35
Q

how do you interpret results of the delta gap

A

if corrected HCO3 is less than normal, there is an additional metabolic acidosis present
if corrected value of HCO3 is greater than 26, there is a co-existing metabolic alkalosis present

36
Q

chronic respiratory alkalosis equations

A

pH=7.4-0.003(pCO2-40)

HCO3=24+0.5(pCO2-40)

37
Q

acute respiratory alkalosis equations

A

pH=7.4-0.008(pCO2-40)

HCO3=24+0.2(pCO2-40)

RC Test 2 (17 decks)

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