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FDN Week 5 (Block 2) > Dr. Winter - Acid / Base > Flashcards

Dr. Winter - Acid / Base Flashcards

1
Q

What do you get from an arterial blood gas? (ABG)

A

pH Direct
pO2 Direct
pCO2 Direct
HCO3- Calculated
Hgb Direct
Hgb saturation Direct (co-oximetry) or calculated

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2
Q

A pH change of “1” is equal to

A

a ten fold change in acidity / basicitiy

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3
Q

What is the reference interval for acidosis / alkilosis

A

<7.35 Acidic

>7.45 Basic

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4
Q

What things other than pH must be maintained in homeostasis?

A

Protein concentration

Temperature

Ion concentration

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5
Q

What is the energy currency of the cell?

A

Glucose

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6
Q

What is required for ATP synthesis to occur?

A

Fuel source: Glucose, AA, FA’s

O2 for aerobic respiration

excretion via lungs and urea cycle

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7
Q

What is the primary mechanism by which the body maintains pH?

A

By a chemical buffer system using HCO3

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8
Q

What is the equation we use to work acid / base problems?

A

H20 + CO2 —> H+ + HCO3

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9
Q

Lower the pKa =

A

stronger the acid

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10
Q

What are other sources of acid other than CO2?

A

Ketoacids and Lactic Acids

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11
Q

What is the source of lactic acid?

A

Inadequate O2 delivery to tissue - anaerobic meabolism

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12
Q

What is the source of ketoacids?

A

Uncontrolled DMT1 or alcohol + starvation

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13
Q

What are the indications for CO2?

A

pCO2 being high means that we are retaining it and pH is low i.e. respiratory acidosis.

pCO2 being low is an indication that we are expelling more than production i.e. hyperventilation. The result is respiratory alkolosis.

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14
Q

There are two contributing factors to pCO2 levels they are?

A

Production rate (minor impact)

excretion rate (high impact)

Excretion of CO2 is by respiration so, MV = RR x TV

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15
Q

How does CO2 and O2 gas diffusion compare?

A

CO2 gas diffusion is 24x faster than O2.

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16
Q

What acids are breathed out via respiration?

A

volatile acids i.e. ketoacids, lactic acids and carbonic acids.

17
Q

What acids are excreted via the urine?

A

nonvolatile acids: Onces that contain phosphorus, nitrogen or sulfur.

18
Q

What are the indication of acid / base imbalance?

A

respiration is important for acid / base balance the tachypenia and deep breathing are indications of acid / base imbalance.

19
Q

When someone has metabolic acidosis how does pH, pCO2 and HCO3 change?

A

pH drops = acidosis

pCO2 drops as a compensitory response to increased acidity

HCO3 drops as it is being used as a buffer

20
Q

When someone has respiratory acidosis what is the change in pCO2, pH and HCO3?

A

Retaining CO2 so pCO2 goes up

pH goes down - this is acidosis

HC03 stays the same or slight increase

21
Q

When someone has combined respiritory and metabolic acidosis what is the change in pCO2, pH and HCO3?

A

pH drops - this is acidosis afterall

pCO2 goes up due to respiratory retention

HCO3 goes down as a buffer for HA additiion

22
Q

What are the two conceptual causes of metabolic acidosis?

A

H2O + CO2 —> H+ + HCO3

Addition of H+ via ketosis or lactic acid

Insufficient HC03 produced in kidney: lack of reabsorption in the proximal tubule or production in the distal tubule.

23
Q

What are the two ways that the body can “lose” HCO3?

A

A pancreatic fistula or diarrhea.

24
Q

How do we differentiate between the loss of HCO3 or addition of HA as the source of metabolic acidosis?

A

Loss of HCO3- requires the replacement with Cl- in order to maintain electrical balance. This is loss via pancreatic fistual or diarrhea.

When the acidosis is caused via HA addition we see no change of Cl-

In both cases we see a drop of HCO3 for two different reasons.

25
Q

How to calculate anion gap?

A

Na+ - (HCO3- + Cl-)

reference interval is generally < 12-15

26
Q

What is the more reliable measurement of the type of metabolic acidosis?

A

Anion gap is a better measurement. Why? Cl- follows Na+ so hypontremia can pull down Cl- into the refernce interval yet it is still elevated in comparison to Na.

27
Q

What do we measure to confirm the presence of DKA?

A

We measure for increased BHB and urine ketones.

FDN Week 5 (Block 2) (10 decks)

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