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AP II Test 1 > Dr. Sullivan: Acid-Base Interpretation > Flashcards

Dr. Sullivan: Acid-Base Interpretation Flashcards

1
Q

What are the 4 main acids that can be found in the human body?

A
  • carbonic acid
  • lactic acid
  • aspirin/methanol/ethanol
  • uremia/DKA

Note: DKA is diabetic ketacidosis

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2
Q

Intracellular buffering comes from what? (2)

A

proteins

phosphates (bones)

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3
Q

Extracellular buffering comes from what? (2)

A

bicarbonate

ammonia

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4
Q

What are 2 major organ systems?

A

lungs

kidneys

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5
Q

Lungs can compensate in about ___ min whereas the kidneys compensate in _____ hours.

A

10

72

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6
Q

PCO2 in arterial blood is ______mmHg.

A

40 mmHg

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7
Q

PCO2 in venous blood is ______ mmHg.

A

45

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8
Q

What would you expect to change in a respiratory acid-base disturbance?

A

PaCO2

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9
Q

What would you expect to change in a metabolic acid-base disturbance?

A

HCO3-

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10
Q

When a stress is applied to a system, the balance is shifted in the direction to relieve that stress is known as what principle?

A

Le Chatlier’s Principle

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11
Q

What enzyme makes this reaction occur?

CO2 + H2O ⇔ H2CO3 ⇔ H+ + HCO3-

A

carbonic anhydrase

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12
Q

What is the most important buffering system?

A

HCO3 - CO2 buffering system

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13
Q

First questions to ask yourself during an ABG analysis: (4)

This is known as figuring out the primary disorder.

A
  1. Is there acidemia or alkalemia?
  2. Is the problem respiratory or metabolic?
  3. If respiratory, is it chronic or acute?
  4. If metabolic, IS THERE AN ANION GAP?
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14
Q

To determine if there is a secondary disorder, ask yourself this question:

A

Is there compensation?

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15
Q

If anion gap acidosis is present, what do you ask yourself?

A

Are there any other underlying metabolic disorders?

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16
Q

What is present if either the PaCO2 or the pH is outside the normal range?

A

acid base abnormality

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17
Q

A normal pH or a normal PaCO2 does not rule out the presence of an acid-base disturbance. True or false?

A

true

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18
Q

If both PaCO2 and pH change in the same direction then the disturbance is _______.

A

metabolic

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19
Q

If both paCO2 and pH change in opposite directions then the disturbance is ______.

A

respiratory

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20
Q

If there is a respiratory disturbance, what must you do?

A

calculate expected pH

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21
Q

What is the ∆pH equation for an acute respiratory change?

A

∆PaCO2 x 0.008

22
Q

What is the ∆pH for a chronic change?

A

∆PaCO2 x 0.003

23
Q

If there is an anion gap then there is an excess of proton donors. If there is not a gap, then there is a loss of proton acceptors. Normal AG is _____.

A

12 ± 4

24
Q

What is the Anion Gap equation?

A

Na - Cl - HCO3

25
Q

If anion gap is greater than 12, what do we conclude the patient has?

A

anion gap acidosis

26
Q

If the patient has a metabolic issue, what is the factor to determine next?

A

We need to ask:

“Is this a anion gap or non-anion gap metabolic issue?”

27
Q

If anion gap is less than 12, what can we safely conclude?

A

This is a non-anion gap acidosis.

28
Q

Anion gap calculation is made to determine if a metabolic acidosis is due to an accumulation of _________ or a net loss of _________.

A

non-volatile acids

bicarbonate

29
Q

Pearl:

If you have a normal pH and a PaCO2 that is out of range, what can you DEFINITELY conclude?

A

3rd disorder is present.

30
Q

If pH or PaCO2 are normal, then what do you conclude?

A

There is a mixed metabolic and respiratory disturbance.

31
Q

Rule 3: : If pH or PaCO2 are normal, there is a mixed metabolic and respiratory disturbance

If the pH is normal then the direction of change of the PaCO2 determines what?

A

respiratory disorder

32
Q

Rule 3: If pH or PaCO2 are normal, there is a mixed metabolic and respiratory disturbance

If the PaCO2 is normal, the direction of change or the pH identifies what?

A

metabolic disorder

33
Q

If a primary metabolic acidosis or alkalosis, use the measured serum bicarbonate concentration to identify the expected PaCO2.

If the measured and calculated PaCO2 are similar, then the disturbance is _______.

A

compensated

34
Q

You cannot have both respiratory acidosis and alkalosis. True or false?

A

true

35
Q

If a primary metabolic acidosis or alkalosis, use the measured serum bicarbonate concentration to identify the expected PaCO2.

If the measured and calculated PaCO2 are different, then the disturbance is _______.

A

not compensated

36
Q

If there is a respiratory acidosis or alkalemia, then use the formulas to calculate the expected pH.

Compare the measured pH to the expected pH to determine if the condition is: (3)

A

acute, partially compensated, or fully compensated

37
Q

Given Primary respiratory disorder calculate expected ___.

A

pH

38
Q

Calculating compensation

Given Primary Metabolic disorder calculate expected _______.

A

PaCO2

39
Q

Calculating compensation

What is the PaCO2 ACIDOSIS equation?

A

(1.5 x HCO3) + 8 (±2)

40
Q

What is the PaCO2 ALKALOSIS equation?

A

(0.7 x HCO3) + 21 (±2)

41
Q

For respiratory disorders

If the expected (calculated) pH is different than measured pH, there is a second disorder, which is _____.

A

metabolic

42
Q

For metabolic disorders

If the expected (calculated) PaCO2 is different than measured PaCO2, there is a second disorder, which is ________.

A

respiratory

43
Q

What are the cardiac consequences of acidemia? (4)

A

Impaired contractility
Vascular dysfunction
Reductions in blood flow
Arrhythmogenesis

44
Q

What are the pulmonary consequences of acidemia? (2)

A

Increased MV
Decreased/Fatigued respiratory muscle function

45
Q

What are the metabolic consequences of acidemia? (4)

A

Increased metabolic demands
Insulin resistance
Hyperkalemia
Increased catabolism

46
Q

Overcompensation is common. True or false?

A

False.

It is rare.

47
Q

Loss of bicarbonate may be due to:

MUDPILES

A
  • methanol
  • uremia
  • DKA
  • propylene glycol
  • isoniazid
  • lactic acidosis
  • ethylene glycol
  • salicylates
48
Q

Hemodialysis is effective for lactate acidosis. True or false?

A

false

NOT effective

49
Q

Diuretic therapy is the biggest cause of metabolic alkalosis. True or false?

A

True

50
Q

Number 1 cause for respiratory alkalosis is:

A

pain/anxiety

AP II Test 1 (12 decks)

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