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Block 2; Week 8 > Cremo Simple Acid Base Disturbances > Flashcards

Cremo Simple Acid Base Disturbances Flashcards

1
Q

What determines if a patient is acidemic or alkalemic?

A

Acidemic: pH7.45

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2
Q

If you are acidemic how can you tell if you are in metabolic acidosis or respiratory acidosis?

A

Metabolic Acidosis: HCO3-40

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3
Q

If you have metabolic acidosis, how can you tell if you have non gap acidosis or gap acidosis?

A

Non Gap Acidosis: Anion Gap 12

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4
Q

If you have alkalemia how can you tell if you have respiratory alkalosis or metabolic alkalosis?

A

Metabolic Alkalosis: HCO3- > 24

Respiratory Alkalosis: PaCO2 < 40

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5
Q

If you have respiratory acidosis or respiratory alkalosis how can you tell if it is acute or chronic?

A

If PCO2>10mmHg: & the pH < 0.8: acute
If PCO2 >10mmHg: & the pH < 0.3 chronic
If PCO2 0.8 acute
If PCO2 0.3 chronic

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6
Q

What is the difference b/w acidemia & alkalemia vs. acidosis & alkalosis?

A

Emia refers to the H+ conc’n in the blood

Osis refers a pathological condition–what causes the emia.

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7
Q

What causes respiratory acidosis or alkalosis?

A

Pathological changes in PaCO2.

  • *usu caused by problems with lungs
  • *sometimes caused w/ CO2 poisoning & normal lungs
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8
Q

What causes metabolic acidosis or alkalosis?

A

pathological changes in bicarbonate

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9
Q

Every point on a Davenport Diagram is equal to what?

A

a solution to the Henderson-Hasselbach equation…

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10
Q

What happens when you increase PaCO2?

A

H+ & bicarbonate will rise too.

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11
Q

What is the line called that represents the same CO2 on a Davenport Diagram? An increase in CO2 will cause a shift of the line in which direction?

A

an isopleth

a shift inward

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12
Q

What does the presence of Hb do to an increase in CO2? What is this called?

A

It binds to the H+ and takes them out of circulation. This lessens the increase in conc’n of H+ when you add CO2.
Called a non-volatile buffer

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13
Q

What do non-volatile buffers buffer?

A

CO2 changes. Ex: Hb

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14
Q

What is the slope of Davenport? What does it represent?

A

It is the slope of the buffer line of blood. The line that is made if you connect the changes in bicarbonate conc’n of all of the isopleths.
It reflects the responsive change of bicarbonate.

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15
Q

If you have more nonvolatile buffer available…what does that do to the buffer line in the Davenport diagram?

A

It makes it more steep.

Ultimately, there is more bicarbonate available at lower pHs.

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16
Q

When you get respiratory acidosis–what changes? What line do you move along?

A

PaCO2 changes. So you move onto a different isopleth.

You move along the buffer line of blood.

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17
Q

What does acute mean?

A

It means that it happened minutes or hours ago. It means that the renal system hasn’t had time to buffer it.

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18
Q

What type of ventilation would acute respiratory acidosis correspond to?

A

Hypoventilation

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19
Q

In acute respiratory acidosis–>what wins: strength or load?

A

Load.
Airflow Resistance
Lung Stiffness
Ventilatory Requirement

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20
Q

What are pulmonary explanations for acute respiratory acidosis?

A 
Upper Airway Obstruction: swallow toy car
Severe Asthma attack
COPD
Severe pneumonia
Severe pulmonary edema
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21
Q

What are non-pulmonary explanations for acute respiratory acidosis?

A

Disruption in the neural linkage that drives breathing…
Central nervous system depression
External environment preventing normal breathing

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22
Q

What are 2 examples that cause a central nervous system depression? What is an explanation for an external environment preventing normal breathing?

A

Central Nervous System Depression: drug overdose or anesthesia
External Environment Preventing Normal Breathing: heavy weight on chest

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23
Q

Respiratory Alkalosis corresponds to what line shift? What line movement?

A

Line Shift to a different isopleth. One with a lower PCO2.

This is movement to the right on the buffer line of blood. This corresponds with a small decrease in HCO3-.

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24
Q

What is the role of nonvolatile buffers in respiratory alkalosis?

A

As the CO2 decreases…there is a shift that lessens the amount of HCO3- & H+. But the Hb that is holding onto H+ will let go of some of it & prevent a dramatic decrease in hydrogen ions.

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25
Q

What type of buffer handles CO2 changes?

A

nonvolatile buffers like Hb

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26
Q

What central explanation can explain respiratory alkalosis?

A

An intact neuromuscular chain for breathing

a respiratory center that is pacing the chain to produce high minute ventilation

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27
Q

Respiratory Alkalosis corresponds to what?
Hyperventilation or Hypoventilation
Hypercapnia or Hypocapnia
Increase/Decrease Drive to breathe

A

Hyperventilation (get rid of all of your CO2)
Hypocapnia
Increase in drive to breathe

28
Q

What are 4 conditions that can increase the central drive to breathe & cause respiratory alkalosis?

A
  1. arterial hypoxemia or hypoxia
  2. direct stimulation of pulmonary mechanoreceptors & chemoreceptors by lung disease
  3. Factors that directly stimulate the medullary respiratory center
  4. Psychological factors
29
Q

What are some things that can cause stimulation of the pulmonary mechano & chemoreceptors?

A

inflammatory debris

fever

30
Q

T/F A pulmonary embolus can cause respiratory alkalosis.

A

True.

31
Q

Why does hypoxemia cause respiratory alkalosis?

A

Higher PaCO2 flowing in the medulla stimulates the central chemoreceptor in the medulla. this increases ventilation. Thus, respiratory alkalosis.
Smaller effect: peripheral chemoreceptors in the carotid & aortic bodies…

32
Q

Although they have a less significant effect in producing respiratory alkalosis…what can stimulate the peripheral chemoreceptors in the carotid & aortic bodies?

A

Starts driving breathing when PaO2 falls below 60 mmHg

Lactic acid is released during strenuous exercise…

33
Q

At the beginning of certain pulmonary diseases…acidosis/alkalemia is present & strength/load is winning & then at the end (a dangerous situation) acidosis/alkalosis is present & strength/load is winning.

A

Alkalemia & Strength is winning (hypocapnia)

Acidosis & Load is winning (hypercapnia)

34
Q

What are 3 pulmonary causes of respiratory alkalosis?

A

Bacterial Pneumonia
Pulmonary Embolus
Acute Asthma

35
Q

What are 4 non-pulmonary causes of respiratory alkalosis?

A

Sepsis
Liver Disease
Pregnancy
Psychogenic Hyperventilation

36
Q

T/F Anxiety can cause sepsis.

A

True. A psychological factor of respiratory alkalosis.

37
Q

Respiratory Acidosis corresponds to Hypercapnia/Hypocapnia & Alveolar Hyperventilation/Hypoventilation.

A

Respiratory Acidosis
Hypercapnia
Alveolar Hypoventialtion

38
Q

Respiratory Alkalosis corresponds to Hypercapnia/Hypocapnia & Alveolar Hyperventilation/Hypoventilation.

A

Respiratory Alkalosis
Hypocapnia
Alveolar Hyperventilation

39
Q

What causes metabolic acidosis or alkalosis?

A

caused by pathological change in HCO3-

40
Q

What does EAP stand for?

A

Endogenous Acid Production

41
Q

What does bicarbonate do to buffer when acid is added?

A

the bicarbonate combines with the H+ & shifts the equilibrium to the left to make more CO2. But the pH will still decrease b/c the bicarb can only do so much.

42
Q

In metabolic acidosis…what happens to CO2 & HCO3-?

A

HCO3- decreases b/c it is consumed.

CO2 remains the same. There is movement along the same isopleth.

43
Q

What happens in metabolic alkalosis?

A

this will combine with the extra H+. The bicarbonate system will buffer this by shifting to the right to produce more H+.
this will buffer the increase in pH, but it will still increase.

44
Q

What are the 2 things that can cause metabolic acidosis & hypobicarbonatemia?

A

Increase in EAP

Reduced acid excretion b/c of renal defects

45
Q

What are 3 things the can cause an increase in EAP?

A

Derangements in gut function
Derangements in metabolism
Due to exogenous intoxicants

46
Q

What are the 2 gastrointestinal causes of EAP & metabolic acidosis?

A

Diarrhea

Laxative Abuse

47
Q

Why is there a gastrointestinal cause of metabolic acidosis?

A

When you increase stool volume & HCO3- excretion…there is an increase in HCO3- secretion in to the blood & therefore H+.

48
Q

What is the main buffer of metabolic & gastric acid production?

A

the bicarbonate system

49
Q

Why can metabolic acidosis be caused by decreased perfusion? What are 2 examples of this?

A 
with lower perfusion & oxygen delivery...you can't complete the metabolic breakdown of organic acids. So you get a buildup of H+ from their breakdown. 
Lactic Acidosis (strenuous exercise)
Ketoacidosis (Type I Diabetes)
50
Q

What is an exogenous cause of metabolic acidosis?

A

Methanol consumption. Breaks down to an acid…

51
Q

What are 2 causes of metabolic alkalosis?

A

Vomiting Nasogastric drainage

52
Q

How does vomiting cause metabolic alkalosis?

A

Loss of H+

Production of more H+ & therefore HCO3- spills into the blood.

53
Q

What are the 3 maintenance mechanisms that keep the pH from going back to normal after vomiting thru increased bicarbonate excretion?

A

Volume Depletion
Hypokalemia
Aldosterone Excess

54
Q

What is compensation? What is its purpose?

A

Change in bicarbonate or PCO2 that counteracts the primary disturbance. Its purpose is to return pH back to normal…but it will never reach 7.4

55
Q

A zone on the Davenport diagram going along the buffer line represents what?

A

Acute Respiratory Acidosis & Alkalosis

56
Q

A zone on the Davenport diagram going from 10 o’clock to 4 o’clock represents what?

A

Chronic Respiratory Acidosis & Alkalosis

57
Q

A zone on the Davenport diagram going from the 1 o’clock to 7 o’clock represents what?

A

Metabolic acidosis & alkalosis

58
Q

What is Phase 1 of Chronic Respiratory Acidosis?

A 
First 10 minutes
Alveolar Ventilation decreases
CO2 excretion decreases
PaCO2 increases
partial mitigation of the pH change thru body buffers
59
Q

What is Phase 2 of Chronic Respiratory Acidosis?

A

Renal Compensation
Increase in H+ excretion
Increase in HCO3- reabsorption
pH returns to normal

60
Q

How long does it take for renal compensation of chronic respiratory acidosis? Chronic respiratory alkalosis?

A

Chronic Respiratory Acidosis: 4 days

Chronic Respiratory Alkalosis: 8 days

61
Q

Rules of thumb only apply to what situations?

A

Simple, not mixed

62
Q

If you have an acute respiratory acidosis…what hasn’t happened yet?

A

Compensation. Renal…

63
Q

T/F There is not an acute & chronic metabolic acidosis, only one type b/c of how fast respiratory compensation is.

A

True

64
Q

What is the Winter’s Formula? What does it represent?

A

PaCO2=1.5 X HCO3- + 8 (+/-2)

**expected respiratory compensation in response to metabolic acidosis

65
Q

What is the formula that tells if metabolic alkalosis is properly compensated?

A

PaCO2=0.7 X HCO3- + 20 (+/-5)

**expected respiratory compensation in response to metabolic alkalosis

Block 2; Week 8 (6 decks)

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