Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles I* > E2- ABGs > Flashcards

E2- ABGs Flashcards

1
Q
  • In order to ensure optimal function of __________ function, acid-base balance is tightly regulated at what pH?
  • changes in [] of F/E - changes waters ability to ____?
  • 1831 = O’Shaughness discovrered ?? in what pts?
A
  • enzymatic
  • 7.35 to 7.45
  • auto-ionize
  • loss of carbonate of soda in CHOLERA pts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes acidemia?

A
  • Excess production of H+ (in relation to hydroxyl ions)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What causes alkalemia?

A
  • Excess production of OH- (in relation to hydrogen ions)

OH = hydroxyl ions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is known as the measured hydrogen concentration?

A
  • pH

The Power of Hydrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The stability of pH is managed by what 3 factors?

A
  • CO2 = enters/leaves the body via lungs
  • HCO3 = enters/leaves the body via kidneys = via proximal tubule
  • H+ = reabsorbed = via distal tubule + collecting duct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the equation to calculate “acid-base balance”?

A

Henderson-Hasselbalch equation

pH = 6.1 + log [ serum bicarb / (0.03 x PaCO2) ]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • Water can be acid or base + is considered ______?
  • _____ is a strong acid that _______ proton w/ water
  • _____ is a strong base that ______ proton w/ water
A
  • amphoteric
  • HCl - donates to water
  • KOH - receives from water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • Degree of dissociaition in water determines what?
  • _____ has a pKa of 3.4 ,, completely dissociates = strong acid
  • ______ has a pKa of 6.4 ,, partially dissociates = weak acide
A
  • strength
  • lactic acid
  • carbonic acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 rules

Describe Electrical Neutrality

A

o Add all positive + negative charges – should be EQUAL to each other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 rules

Describe Dissociation Equilibria

A

o The propensity of substance to dissociate
o Put chunk of substance into water + it wants to break up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

3 rules

Describe Mass Conservation

A

o The amount of substance remains constant
o Not in size ,, but amount
o Cannot create or lose substance unless another process interfering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most abundant ECF strong cation + anion?
Other ones?

A

**Na+, Cl- **

K+, SO42-, Mg2+, Ca2+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • Thestrong ion difference is the ability of ECF to maintain a more _______ environment.
  • It is an __________ predictor of pH
  • Equation?
A
  • positive
  • independent
  • total = strong cations - strong anions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • acid-base disorder= primary disorder with secondary compensation?
  • acid-base disorder = mixed acid/base problem?
A
  • Both PaCO2 + HCO3 change in same direction
  • PaCO2 + HCO3 in different directions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the Acid/Base Disorder
pH: 7.34
PCO2: 48
HCO3: 24

A

Uncompensated Respiratory Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the Acid/Base Disorder
pH: 7.58
PCO2: 38
HCO3: 29

A

Uncompensated Metabolic Alkalosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Acid/Base Disorder
pH: 7.28
PCO2: 46
HCO3: 18

A

MIXED met/resp acidsois

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the Acid/Base Disorder
pH: 7.48
PCO2: 32
HCO3: 22

A

Uncompensated Respiratory Alkalosis
probs starting to compensate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

5 Cardiovascular Consequences of Acidosis

A
  • Impaired contractility = pH 7.2
  • Decreased arterial bp
  • Sensitive to re-entry dysrhythmias
  • Decrease threshold for V-fib
  • Decreased responsiveness to catecholamines = pH 7.1

CBD is VC (very cool)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

2 Nervous System Consequence of Acidosis

A
  • Obtundation
  • Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 Pulmonary Consequences of Acidosis

A
  • Hyperventilation (d/t compensation, blowing off CO2)
  • Dyspnea
  • Respiratory Muscle Fatigue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

3 Metabolism Consequence of Acidosis

A
  • Hyperkalemia (contributes to reentry dysrhythmias)
  • Insulin Resistance
  • Inhibition of anaerobic glycolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Define Respiratory Acidosis

A
  • An acute decrease in alveolar ventilation resulting in increase PaCO2
  • pH < 7.35
  • Caused by respiratory failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the causes of Respiratory Acidosis?

A
  • Drug-induced ventilatory depression
  • Permissive hypercapnia
  • Upper airway obstruction
  • Status asthmaticus
  • Restriction of ventilation (rib fx, flail chest)
  • Disorder of neuromuscular function
  • MH
  • PNA/ Pulmonary Edema, Pleural Effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How do we cause Resp Acidosis?

A

inadequate NMBD reversal
opioid excess
CO2 insufflation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the 3 categories that can cause Respiratory Acidosis?

A
  • Central ventilation control (neuro/brain)
  • Peripheral ventilation control (neuromuscular disease)
  • VQ mismatch (Pneumonia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

ACUTE hypercarbia, how long does it take for the bicarb to compensate for the acid-base disorder?

PaCO2 increases by 10 mmHg = increase _______ mEq/L of HCO3- for system to be compensated

A
  • Very slowly (2-3 days)
  • Increase in **1 mEq/L **of HCO3 for every 10 mmHg of PaCO2

COPD from 40 > 50 ,, Bicarb from 24 >25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How much will HCO3- increase with compensated CHRONIC hypercarbia?

A
  • ↑ PaCO2 of **10 mmHg **= ↑ HCO3- by 3 mEq/L

This is prevalent in COPD patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Upon arrival at the ICU, the patient has a PaCO2 of 80 mmHg.

What is the expected HCO3 if this patient has compensated ACUTE hypercapnia?

A

* 28 mEq/L

Normal PaCO2 : 40 mmHg
Normal HCO3 : 24 mEq/L
PaCO2 = =80 mmHg
PaCO2 **increased by 40 mmHg **
For acute hypercapnia, every 10 mmHg PaCO2 = ↑HCO3 by 1 mEq —- increase by 4

Below 28 = add aggressive treatment bc body not compensate

30
Q

Upon arrival at the ICU, the patient has a PaCO2 of 80 mmHg.

What is the expected HCO3 if this patient has compensated CHRONIC hypercapnia?

A

* 36 mEq/L

Normal PaCO2 level: 40 mmHg
Normal HCO3 level: 24 mEq/L
PaCO2 of the patient is 80 mmHg
PaCO2 increased by 40 mmHg
Chronic Hypercapnia: ↑PaCO2 10 mmHg=↑HCO3- 3 mEq
HCO3- increase by **12 mEq/L **
Expected HCO3- = 24 + 12 = 36 mEq/L

31
Q

What would be the treatment for respiratory acidosis :: if hypercarbia is marked + CO2 narcosis is present?

A
  • Mechanical Ventilation
32
Q

Why should there be caution with chronic hypercarbia reversal with bicarb?

A
  • Excessive bicarb will cause CNS irritability&raquo_space; seizures
33
Q

Define Metabolic Acidosis.

A
  • A lowered blood pH - stimulates respiratory center to hyperventilate
  • Metabolic Acidosis is secondary to an underlying disorder (fix the problem to fix acidosis)

Respiratory compensation does not fully counter excessive acid production

34
Q

Metabolic Acidosis is associated with alterations in transcellular ____________ and ↑ ionized calcium.

A
  • ion pumps
35
Q

What direction will the Oxygen-Hemoglobin Dissociation Curve shift with Metabolic Acidosis?

A
  • Rightward Shift
  • This will allow O2 to be released and available to the tissues
36
Q

What is your expected PaCO2 if your HCO3- is 12 mEq/L?

A
  • PaCO2 = 26 mmHg
  • If PaCO2 is HIGHER 26 mmHg, compensation is INADEQUATE

**PaCO2 = (1.5 x HCO3-) + 8 **
= (1.5 x 12) + 8
= 26 mmHg

37
Q

For every 1 mEq/L of negative base excess, PaCO2 should fall ______ mmHg.

A
  • 1.2 mmHg
  • otherwise inadequate compensation
38
Q

A normal anion gap maintains __________.

A
  • Electrical neutrality
39
Q

Bicarb loss is countered by the net gain of ______ ions. Often called ?

A
  • Chloride ions
  • often called hyperchloremic metabolic acidosis
40
Q

3 cause metabolic acidosis + normal anion gap.

A
  • Sodium Chloride Infusion
  • Diarrhea
  • Early Renal Failure

Sure dad extra little kidneys really poop (suck)

41
Q

What defines a high anion gap?

A
  • > 20 mEq/L
  • Additional acid that is added to extracellular space
  • Acids dissociates into H+ - combine with bicarb - form carbonic acid - decrease available bicarb
42
Q

4 Causes of high anion gap.

A
  • Lactic Acidosis
  • Ketoacidosis
  • Renal Failure
  • Poisoning

Sure dad extra little kidneys really poop (suck)

43
Q

Mneumonic for High Anion Gap Acidosis

A

* CAT MUDPILES

  • C: Cyanide + CO
  • A: Arsenic
  • T: Toluene
  • M: Methanol + Metformin
  • U: Uremia
  • D: DKA
  • P: Paraldehyde
  • I: Iron
  • L: Lactate
  • E: Ethylene glycol
  • S: Salicylates
44
Q

What is the simple anion gap formula?

What is the range of a simple anion gap?

A
  • Sodium - (Chloride + Bicarb)
  • 12-14 mEq/L
45
Q

What is the conventional anion gap formula?

What is the range of a conventional anion gap?

A
  • (Sodium + Potassium) - (Chloride + Bicarb)
  • 14-18 mEq/L
46
Q

Anion Gap frequently ___________ (overestimates/underestimates) the extent of acid-base disturbances.

A
  • Underestimates
  • complicated by hypo-albumin ,, hypo-phosphate

This is complicated by hypoalbuminemia and hypophosphatemia

47
Q

Lactic Acidosis

A
48
Q

How do you treat metabolic acidosis?

A
  • Treat the cause!
49
Q

Treatment for Metabolic Acidosis related to Ketoacidosis.

A
  • Insulin and fluids
50
Q

Treatment for Metabolic Acidosis related to Lactic Acidosis.

A
  • Improve tissue perfusion
  • Dc Metformin
  • fluids
51
Q

Treatment for Metabolic Acidosis related to Renal Failure.

A
  • Dialysis
52
Q

What are the parameters to treat metabolic acidosis with sodium bicarbonate?

A
  • pH **< 7.1 **
  • HCO3- < 10 mEq/L
53
Q

What are the negative effects of administering bicarb to someone with metabolic acidosis?

A
  • Bicarb will react with H+ ion and generate CO2 which will diffuse intracellularly and decrease pH
  • In chronic metabolic acidosis, acute pH changes negate the right shift curve (Bohr effect) and cause tissue hypoxia

The administration of IV NaHCO3 to treat metabolic acidosis should be reserved for the emergency treatment of select conditions

54
Q

Formula for HCO3- Correction Dose

A
  • Dose of Bicarb = 0.3 x Base Deficit x Wt (kg)
  • Give 1/2 dose

Oftentimes, you would give half this dose and reassess

55
Q

2 reasons treat with bicrb is controversial?

A
  1. reacts with H to decrease pH more
  2. in chronic met. acidsosis - pH change negates Rigth shit + can’t get oxygen to tissue
56
Q

What happens to elective surgery if the patient experience acute metabolic acidosis?

A
  • Surgery will be postponed
57
Q

Anesthesia management considerations for urgent/emergent surgery with metabolic acidosis.

A
  • Hemodynamic monitoring
  • Give Fluids
  • Monitor Cardiac Functions
  • Frequent Lab - POCUS q30 min
58
Q

Define Respiratory Alkalosis.

A
  • An acute increased alveolar ventilation
  • Results in ↓ PaCO2 and pH > 7.45
59
Q

What are 5 causes of Respiratory Alkalosis?

A
  • Anxiety
  • Pregnancy
  • High Altitude (↑RR)
  • Salicylate overdose (asprin)
  • Iatrogenic hyperventilation (during perioperative period/ fear)
60
Q
  • What does decrease PaCO2 cause?
  • What are the symptoms of Respiratory Alkalosis?
A
  • Decrease PaCO2 will cause vasoconstriction
  • Lightheadedness
  • Visual disturbance
  • Dizziness
61
Q

Respiratory Alkalosis will result in greater binding of calcium to ________.

A
  • Albumin

Patient will be hypocalcemic.

62
Q

What are the signs and symptoms of hypocalcemia?

A
  • Paresthesia, muscle spasm, cramp, tetany, circumoral numbness, seizures
  • Trousseau’s sign
  • Chvostek’s sign (Irritability on the facial nerve)
63
Q

Anesthesia management of respiratory alkalosis.

A
  • Consider what is causing the hyperventilation (anxiety)
  • Consequence of Pain, Full Bladder, Agitation
  • Poor mechanical ventilation strategy
  • Therapeutic Hyperventilation
64
Q

Define Metabolic Alkalosis.

A
  • Marked increase in plasma bicarb usually compensated by an increase in CO2
  • Renal or extrarenal causes
  • Net loss of H+ or a net gain of bicarb
  • excess citrate
65
Q

What are other names for Metabolic Alkalosis?

A

* Volume depletion alkalosis
* **Volume overload **alkalosis

66
Q

What are 6 causes of Metabolic Alkalosis?

A
  • getting rid of acid !
  • Hypovolemia
  • Vomiting
  • NG suction
  • Diuretic Therapy
  • Bicarb administration
  • Hyperaldosteronism (Conn’s ↑ Na+, ↓ K+)
67
Q

Symptoms of metabolic alkalosis?

A

d/t calcium imbalance
o Lightheadedness, tetany, paresthesia

68
Q

Treatment for Metabolic Alkalosis?

A
  • Treat the cause!
69
Q

Treatment for Metabolic Alkalosis related to volume depletion.

A
  • Saline fluid resuscitation
70
Q

Treatment for Metabolic Alkalosis related to gastric loss.

A
  • Proton Pump Inhibitors
71
Q

Treatment for Metabolic Alkalosis related to loop diuretics.

A
  • Potassium-sparing diuretics (Spironolactone)

Principles I* (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions