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METABOLISM 2 > Clinical Acid-Base > Flashcards

Clinical Acid-Base Flashcards

1
Q

How would pH, HCO3- and pCO2 be affected in a metabolic acidosis?

A

pH: decreased
HCO3: decreased
pCO2: decreased

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2
Q

How would pH, HCO3- and pCO2 be affected in a metabolic alkalosis?

A

pH: increased
HCO3: increased
pCO2: increased

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3
Q

How would pH, HCO3- and pCO2 be affected in an acute respiratory acidosis?

A

pH: decreased
HCO3: increased
pCO2: increased

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4
Q

How would pH, HCO3- and pCO2 be affected in a chronic respiratory acidosis?

A

pH: decreased
HCO3: very increased
pCO2: increased

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5
Q

How would pH, HCO3- and pCO2 be affected in an acute respiratory alkalosis?

A

pH: increased
HCO3: decreased
pCO2: decreased

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6
Q

How would pH, HCO3- and pCO2 be affected in chronic respiratory alkalosis?

A

pH: increased
HCO3: very decreased
pCO2: decreased

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7
Q

Write the bicarbonate buffering equation

A

H+ + HCO3- H2CO3 H2O + CO2

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8
Q

What are the causes of respiratory alkalosis?

A

Hyperventilation which may be caused by stress, exercise, septic shock, altitude, pregnancy and drugs such as salicylate and doxapram

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9
Q

What are the compensatory mechanisms for respiratory alkalosis?

A
  • H+ levels are increased due to decreased distal renal acid secretion
  • HCO3- levels fall due to increased proximal renal excretion of bicarbonate
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10
Q

What are the causes of respiratory acidosis?

A

Hypoventilation which may be caused by:

  • Loss of hypoxic drive (CNS dysfunction)
  • Restrictive chest wall abnormalities e.g. kyphoscoliosis, pneumothorax, obesity
  • Type 2 respiratory failure (hypoxia with hypercapnia) e.g. COPD or status asthmaticus
  • Myaesthesia gravis (neurological impairment of chest wall movement)
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11
Q

What are the compensatory mechanisms for respiratory acidosis?

A

Increased bicarbonate levels in order to buffer the excess H+ (produced due to equilibrium shift as a result of excess CO2 retention)

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12
Q

What are the causes of metabolic alkalosis?

A

Decreased H+ and/or increased HCO3- levels

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13
Q

What may cause the reduction in H+ levels that leads to the development of metabolic alkalosis?

A
  • Vomiting (loss of stomach acid/HCl)
  • Hypokalaemia; extracellular K+ falls and therefore potassium moves out of cells and into the blood, so to retain electroneutrality H+ moves out of the blood and into the cells –> plasma H+ fall
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14
Q

What may cause the increase of HCO3- levels that leads to the development of metabolic alkalosis?

A

Iatrogenic causes (drug-induced) such as antacids (contain bicarbonate)

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15
Q

What are the compensatory mechanisms for metabolic alkalosis?

A

Hypoventilation (to retain carbon dioxide)

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16
Q

What are the causes of metabolic acidosis?

A

Gain of H+ and/or decrease in HCO3-

17
Q

What may cause the increased H+ level that leads to the development of metabolic acidosis?

A
  • Increased organic acid production e.g. lactate or ketones (elevated anion gap)
  • Reduced H+ secretion in the distal tubules due to renal failure
18
Q

What may cause the decreased bicarbonate level that leads to the development of metabolic acidosis?

A
  • Diarrhoea
  • Renal failure causing an inability to reabsorb bicarbonate in the proximal tubules
  • Carbonic anhydrase inhibitors (prevent the conversion of H2CO3 into the ionic form and therefore bicarbonate cannot be reabsorbed)
19
Q

What is the cause of a normal gap metabolic acidosis?

A

Increased loss of bicarbonate leading to compensation via hyperchloraemia

20
Q

What are the causes of an elevated gap metabolic acidosis? (KUSMALE)

A 
Ketoacidosis
Uraemia
Salicyclate poisoning
Methanol
Aldehyde
Lactate
Ethylene glycol intoxication
21
Q

What is the main difference in terms of compensation between normal and elevated gap metabolic acidosis?

A

In normal gap there is chloride compensation (hyperchloraemia) to retain electro-neutrality due to bicarbonate loss

22
Q

What is the physiologic pH value range?

A

7.35-7.45

23
Q

What is the normal pCO2 range?

A

35-45mmHg

24
Q

What is the normal pO2 range?

A

72-104mmHg

25
Q

What is the normal bicarbonate concentration range?

A

22-30mEq/L

26
Q

What is the normal oxygen saturation range?

A

95-100%

27
Q

What is the normal anion gap range?

A

12-16mEq/L

28
Q

What acid-base imbalance may result from profuse vomiting and why?

A

Metabolic alkalosis due to loss of H+ from the stomach acid

29
Q

What acid-base imbalance may occur as a result of shock and why?

A

Elevated metabolic acidosis due to the systemic vasoconstriction in shock leading to hypoxia and hypo perfusion of tissues and subsequently anaerobic respiration leading to lactate build up.

30
Q

What two drugs may induce hyperventilation?

A

Salicyclates and doxapram

METABOLISM 2 (33 decks)

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