Barnes acid base

Question 1

Compensation acute resp acidosis?

Answer 1

Expected [HCO3-] = 24 + {(Actual pCO2-40)/10}

Question 2

Compensation chronic resp acidosis?

Answer 2

Expected [HCO3-] = 24 + {4(Actual pCO2-40)/10)}

Question 3

Compensation resp alkalosis?

Answer 3

Expected [HCO3-] = 24- {2(40-Actual pCO2)/10}

Question 4

Compensation chronic resp alkalosis?

Answer 4

Expected [HCO3-] = 24- {5(40-Actual pCO2)/10}

Question 5

Steps for acid base case?

Answer 5

Determine if the blood is Acidemic or Alkalemic

Determine the direction in change of PCO2 and pH (up or down from normal values)
Primary Metabolic ( pH  PCO2) vs. Primary Respiratory ( pH  PCO2) 
Acidosis vs. Alkalosis

Calculate the Anion Gap

Compensation: PCO2 and HCO3-; is there a mixed disorder
Acute Respiratory Acidosis: Expected [HCO3-] = 24 + {(Actual pCO2-40)/10}

Chronic Respiratory Acidosis: Expected [HCO3-] = 24 + {4(Actual pCO2-40)/10)}

Acute Respiratory Alkalosis: Expected [HCO3-] = 24- {2(40-Actual pCO2)/10}

Chronic Respiratory Alkalosis: Expected [HCO3-] = 24- {5(40-Actual pCO2)/10}

Delta Gap; Measured AG – Normal AG; then add to measured HCO3-

Map out your Differential Diagnosis

Treat underlying conditions unless pH in dangerous range, then treat with acute management.

Question 6

Causes for acute resp acidosis?

Answer 6

Central Nervous depression-drugs, CNS event
Neuromuscular disorders-myopathies, neuropathies
Acute airway obstruction-upper airway, laryngospasm, bronchospasm
Severe pneumonia or pulmonary edema
Impaired lung motion-hemothorax, pneumothorax
Thoracic cage injury-flail chest
Ventilator dysfunction

Question 7

Causes of chronic resp acidodsis?

Answer 7

Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Pulmonary edema
Severe Obesity
Neuromuscular disorders (MS, DMD)
Scoliosis

Question 8

Signs and symptoms resp acidosis?

Answer 8

Restlessness
Blurred vision
Anxiety
Confusion
Headache
Slowed breathing

Severe:
Sleepiness
Tremors
Delirium
Coma

Question 9

Causes acute resp alkalosis?

Answer 9

Anxiety
Hypoxia
Pulmonary Embolism
Central nervous disorders
Drugs
Sepsis
Mechanical Ventilation

Question 10

Causes of chronic respiratory alkalosis?

Answer 10

Stress
Thermal insult
High Altitude
Fever
Drug – Salicylate, analeptics

Pregnancy - Progesterone
Sepsis
Hepatic encephalopathy
Mechanical Ventilation

Question 11

Signs and symptoms of respiratory alkalosis?

Answer 11

Hyperventilation
Dizziness
Light-headed
Numbness or spasms of hands and feet

Confusion
Dry mouth
Tingling arms
Palpitations

Question 12

Acute resp acidosis pH,PO2,

PCO2, serum HCO-3?

Answer 12

pH decreased
PO2 decreased
PCO2 increased
Serrum HCO-3 (same/increased)

Question 13

Chronic resp acidosis pH, PO2, PCO2, serum HCO-3?

Answer 13

pH decreased
PO2 decreased
PCO2 increased
Serum HCO-3 increased

Question 14

Acute resp alkalosis pH, PO2, PCO2, serum HCO-3?

Answer 14

pH increased
PO2 same
PCO2 decreased
Serum HCO-3 same/decreased

Question 15

Chronic Resp alkalosis pH, PO2, PCO2, serum HCO-3?

Answer 15

pH increased
PO2 same
PCO2 decreased
Serum HCO-3 decreased