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ANE 8509 Principles of Anesthesia I > Exam 2- Acid-Base Disorders (6/22/23) > Flashcards

Exam 2- Acid-Base Disorders (6/22/23) Flashcards

1
Q

In order to ensure optimal function of enzymatic function, acid-base balance is tightly regulated at what pH?

A
  • 7.35 to 7.45
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2
Q

What causes acidemia?

A
  • Excess production of H+ (in relation to hydroxyl ions)
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3
Q

What causes alkalemia?

A
  • Excess production of OH- (in relation to hydrogen ions)
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4
Q

What is known as the measured hydrogen concentration?

A
  • pH

The Power of Hydrogen

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5
Q

The stability of pH is managed by what three factors?

A
  • CO2 (enters/leaves the body via lungs)
  • HCO3 (enters/leaves the body via kidneys
    Via proximal tubule)
  • H+ (reabsorbed Via distal tubule and collecting duct)
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6
Q

What is the equation to calculate pH?

A

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

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7
Q

How can you tell if an acid-base disorder is a primary disorder with secondary compensation?

A
  • Both PaCO2 and HCO3 change in the same direction
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8
Q

How can you tell if an acid-base disorder is a mixed acid/base problem?

A
  • PaCO2 and HCO3 are in different directions.
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9
Q

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

A

Uncompensated Respiratory Acidosis

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10
Q

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

A

Uncompensated Metabolic Alkalosis

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11
Q

What is the Acid/Base Disorder
pH: 7.28
PCO2: 42
HCO3: 18

A

Uncompensated Metabolic Acidosis

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12
Q

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

A

Uncompensated Respiratory Alkalosis

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13
Q

If your patient has normal lungs, what should their PaO2 be when they are on 60% FiO2?

A
  • PaO2: 240 to 300 mmHg

Normal range of PaO2: 80-100 mmHg
FiO2 of room air is 21%
FIO2 of 60% is about 3x of room air.
PaO2 will be between 240-300 mmHg

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14
Q

Cardiovascular Consequences of Acidosis

A
  • Impaired contractility at pH 7.2
  • Decreased contractility
  • Decreased arterial blood pressure
  • Sensitive to re-entry dysrhythmias
  • Decrease threshold for V-fib
  • Decreased responsiveness to catecholamines at pH 7.1
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15
Q

Nervous System Consequence of Acidosis

A
  • Obtundation
  • Coma
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16
Q

Pulmonary Consequences of Acidosis

A
  • Hyperventilation (d/t compensation, blowing off CO2)
  • Dyspnea
  • Respiratory Muscle Fatigue
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17
Q

Metabolism Consequence of Acidosis

A
  • Hyperkalemia (contributes to reentry dysrhythmias)
  • Insulin Resistance
  • Inhibition of anaerobic glycolysis
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18
Q

Define Respiratory Acidosis

A
  • An acute decrease in alveolar ventilation resulting in increase PaCO2
  • pH < 7.35
  • Caused by respiratory failure
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19
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
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20
Q

What are the three categories that can cause Respiratory Acidosis?

A
  • Central ventilation control (neuro/brain)
  • Peripheral ventilation control (neuromuscular disease)
  • VQ mismatch (Pneumonia)
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21
Q

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

If PaCO2 increases by 10 mmHg, this will increase _______ mEq/L of HCO3- for the system to be compensated.

A
  • Very slowly (2-3 days)
  • Increase in 1 mEq/L of HCO3 for every 10 mmHg of PaCO2
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22
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

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23
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 level: 40 mmHg
Normal HCO3 level: 24 mEq/L
PaCO2 of the patient is 80 mmHg
PaCO2 increased by 40 mmHg
For acute hypercapnia, ↑PaCO2 of 10 mmHg=↑HCO3- of 1 mEq

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24
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

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25
What would be the treatment for respiratory acidosis if hypercarbia is marked and CO2 narcosis is present?
* Mechanical Ventilation
26
Why should there be caution with chronic hypercarbia reversal with bicarb?
* Excessive bicarb will cause CNS irritability leading to seizures
27
Define Metabolic Acidosis.
* A lowered blood pH which stimulates the respiratory center to hyperventilate * Metabolic Acidosis is secondary to an underlying disorder (fix the problem to fix acidosis) ## Footnote Respiratory compensation does not fully counter excessive acid production
28
Metabolic Acidosis is associated with alterations in transcellular ____________ and ↑ ionized calcium.
* ion pumps
29
What direction will the Oxygen-Hemoglobin Dissociation Curve shift with Metabolic Acidosis?
* Rightward Shift * This will allow O2 to be released and available to the tissues
30
What is your expected PaCO2 if your HCO3- is 12 mEq/L?
* PaCO2 = 26 mmHg * If PaCO2 is > 26 mmHg, compensation is INADEQUATE PaCO2 = (1.5 x HCO3-) + 8 = (1.5 x 12) + 8 = 26 mmHg
31
For every 1 mEq/L of negative base excess, PaCO2 should fall ______ mmHg.
* 1.2 mmHg
32
A normal anion gap maintains __________.
* Electrical neutrality
33
Bicarb loss is countered by the net gain of ______ ions.
* Chloride ions * This is often called hyperchloremic acidosis
34
Factors that cause metabolic acidosis with a normal anion gap.
* Sodium Chloride Infusion * Diarrhea * Early Renal Failure
35
What defines a high anion gap?
* Additional acid that is added to extracellular space * Acids dissociates into H+ that combine with bicarb to form carbonic acid that decrease available bicarb
36
Causes of high anion gap.
* Lactic Acidosis * Ketoacidosis * Renal Failure * Poisoning
37
What is the simple anion gap formula? What is the range of a simple anion gap?
* Sodium - (Chloride + Bicarb) * 12-14 mEq/L
38
What is the conventional anion gap formula? What is the range of a conventional anion gap?
* (Sodium + Potassium) - (Chloride + Bicarb) * 14-18 mEq/L
39
Anion Gap frequently ___________ (overestimates/underestimates) the extent of acid-base disturbances.
* Underestimates ## Footnote This is complicated by hypoalbuminemia and hypophosphatemia
40
How do you treat metabolic acidosis?
* Treat the cause!
41
Treatment for Metabolic Acidosis related to Ketoacidosis.
* Insulin and fluids
42
Treatment for Metabolic Acidosis related to Lactic Acidosis.
* Improve tissue perfusion
43
Treatment for Metabolic Acidosis related to Renal Failure.
* Dialysis
44
What are the parameters to treat metabolic acidosis with sodium bicarbonate?
* pH < 7.1 * HCO3- < 10 mEq/L
45
What are the negative effects of administering bicarb to someone with metabolic acidosis?
* 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 ## Footnote The administration of IV NaHCO3 to treat metabolic acidosis should be reserved for the emergency treatment of select conditions
46
Formula for HCO3- Correction Dose
* Dose of Bicarb = 0.3 x Base Deficit x Wt (kg) ## Footnote Oftentimes, you would give half this dose and reassess
47
What happens to elective surgery if the patient experience acute metabolic acidosis?
* Surgery will be postponed
48
Anesthesia management considerations for urgent/emergent surgery with metabolic acidosis.
* Hemodynamic monitoring * Give Fluids * Monitor Cardiac Functions * Frequent Lab * Uphill battle, be honest with family members
49
Define Respiratory Alkalosis.
* An acute increased alveolar ventilation * Results in ↓ PaCO2 and pH > 7.45
50
What are the causes of Respiratory Alkalosis?
* Pregnancy * High Altitude (↑RR) * Salicylate overdose (asprin) * Iatrogenic hyperventilation (during perioperative period/ fear)
51
What are the symptoms of Respiratory Alkalosis?
* Decrease PaCO2 will cause vessel constriction * Lightheadedness * Visual disturbance * Dizziness
52
Respiratory Alkalosis will result in greater binding of calcium to ________.
* Albumin *Patient will be hypocalcemic.*
53
What are the signs and symptoms of hypocalcemia?
* Paresthesia, muscle spasm, cramp, tetany, circumoral numbness, seizures * Trousseau's sign * Chvostek's sign (Irritability on the facial nerve)
54
How many branches of the facial nerve are there? Name them :)
* Five Branches * Temporal * Zygomatic * Buccal * Mandibular * Cervical ## Footnote *Two Zebras Bit My Chicken*
55
Anesthesia management of respiratory alkalosis.
* Consider what is causing the hyperventilation (anxiety) * Consequence of Pain, Full Bladder, Agitation * Poor mechanical ventilation strategy * Therapeutic Hyperventilation
56
Define Metabolic Alkalosis.
* 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
57
What are other names for Metabolic Alkalosis?
* Volume depletion alkalosis * Volume overload alkalosis
58
What are the causes of Metabolic Alkalosis?
* Hypovolemia * Vomiting * NG suction * Diuretic Therapy * Bicarb administration * Hyperaldosteronism (Conn's ↑ Na+, ↓ K+)
59
Treatment for Metabolic Alkalosis?
* Treat the cause!
60
Treatment for Metabolic Alkalosis related to volume depletion.
* Saline fluid resuscitation
61
Treatment for Metabolic Alkalosis related to gastric loss.
* Proton Pump Inhibitors
62
Treatment for Metabolic Alkalosis related to loop diuretics.
* Potassium-sparing diuretics (Spironolactone)

ANE 8509 Principles of Anesthesia I (27 decks)

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