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Patho > Homeostasis > Flashcards

Homeostasis Flashcards

1
Q

Respiratory Acidosis

A

Retention of CO2, low pH

(Compromised gas exchange on lungs-COPD, infection, asthma)

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2
Q

H+

A

Hydrogen

very strong acid

decreased pH

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3
Q

What causes metabolic Acid-Base Disturbances

A

Toxicity, diabetes, renal failure, excessive GI losses

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4
Q

Metabolic Acidosis

A

Result from increased production of acids other than CO2 (DKA)

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5
Q

Metabolic Alkalosis can be caused by:

A

Excess base, retention of Bicarb or prolonged vomiting

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6
Q

How to tell if it’s respiratory

A

PH and PCO2 move in opposite directions

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7
Q

How to tell if it’s metabolic

A

PCO2 is normal or moving in the same direction as pH

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8
Q

What happens during DKA?

A

Anion gap increases
HCO3 level decreases

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9
Q

How do the kidneys compensate for alkalosis?

A

Retaining H+ and excreting HCO3

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10
Q

Which electrolyte imbalance leads to Trousseau’s sign?

A

Hypocalcemia

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11
Q

What results when the kidneys excrete bicarb?

A

Acidosis

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12
Q

Hypokalemia can cause what complications with digitalis?

A

Dig toxicity

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13
Q

What does hyperventilation cause related to PCO2?

A

Increased PCO2

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14
Q

Low concentration of H+ is…

A

Low pH

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15
Q

Low pH is…

A

Acidic

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16
Q

Low concentration of H+ is…

A

Basic (alkaline)

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17
Q

Normal pH

A

7.35-7.45

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18
Q

PCO2

A

35-45 mm Hg

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19
Q

PO2

A

90-100 mm Hg

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20
Q

Normal HCO3-

A

22 to 26mEq/L

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21
Q

SaO2

A

85-100%

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22
Q

What are the 3 buffer systems?

A

Proteins
Phosphates
Carbonic acid-bicarb system

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23
Q

Retained CO2 equation

A

CO2 + H2O = H2CO3 = HCO3-+H+

When CO2 levels are elevated the equation moves right (creates hydrogen & bicarb)

When H+ levels are elevated, the equation moves left creating more CO2

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24
Q

Bicarbonate

A

HCO3-

Normal value 22-26

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25
Q

We can convert CO2 to…

A

Bicarbonate and H+

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26
Q

We can convert bicarbonate and H+ to…

A

H+ and CO2

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27
Q

The level of CO2 relates directly to the level of…

A

H+

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28
Q

More CO2 = _______ hydrogen
Less CO2 = ________ hydrogen

A

More/Less

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29
Q

ABGs
pH high
CO2 high

A

saME MEtabolic (Metabolic Alkalosis)

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30
Q

ABGs
pH low
CO2 low

A

saME MEtabolic (Metabolic Acidosis)

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31
Q

ABGs
pH high
CO2 low

A

REverse REspiratoy (Respiratory Alkalosis)

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32
Q

ABGs
pH low
CO2 high

A

REverse REspiratoy (Respiratory Acidosis)

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33
Q

Anion Gap

A

Normal metabolic parameter;
figured by subtracting anions from cations (negatives from positives)

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34
Q

2 cations

A

positively charged ions

K+
Na+

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35
Q

2 anions

A

negatively charged ions

Cl-
HCO3-

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36
Q

Normal K+ range

A

3.5-5.2

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37
Q

Normal Na+ range

A

135-145

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38
Q

Normal Cl- range

A

96-106

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39
Q

Normal HCO3- range

A

22 to 26

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40
Q

Normal cation range

A

138.5 - 150.2 mEq/L

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41
Q

Normal anion range

A

118 - 132

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42
Q

Anion Gap

A

Difference of cations minus anions

Normal value 8-16

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43
Q

Anion Gap
Less HCO3- means _________ gap

A

Bigger

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44
Q

Metabolic Acidosis with an INcreased AG is found in;

A

Lactic acid
Ketoacidosis
Renal failure
Overdose of ASA
Indigestion of methanol or ethylene

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45
Q

Metabolic Acidosis with NORMAL AG found in:

A

GI loss of HCO3-
Increased renal HCO3- loss
Hypoaldosteronism
Ingestion of ammonium chloride
Hyperalimentation

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46
Q

K+ normal values

A

3.5 - 5

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47
Q

Hyperkalemia

A

Heart- Tight and Contracted
ST elevation, V Fib,
hypotension, bradycardia
GI - Tight and Contracted
Diarrhea, hyperactive bowel
Neuromuscular
Paralysis in extremities, increased DTRs

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48
Q

Hypokalemia S/S

A

Heart- low and slow
Flat T waves, ST depression,prominent

Muscular- low and slow
Decreased DTRs, Muscle cramping, flaccid paralysis

GI- low and slow
Decreased motility/bowel sounds, constipation, abdominal distention

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49
Q

Hypocalcemia Strong B’s

A

Bones
Blood
Beats

50
Q

Ca+ lab values

A

8 - 10.5

51
Q

Hypocalcemia s/s

A

Trousseau’s sign
Chvosteck”s
Diarrhea
Circumoral Tingling

52
Q

Hypercalcemia

A

Swollen and Slow - moans, groans, & stones

Constipation
Bone pain
Stones
Decreased DTRs

53
Q

Mag levels

A

1.3 - 2.1

54
Q

Hypomagnesemia
s/s

A

EKG-ST depression, T wave inversion, Vfib, tachycardia

Hypereflexia, increased DTRs

Nystagmus

Diarrhea

55
Q

Hypermagnesemia

A

Prolonged PR intervals, heart block

Hyporeflexia-increased DTRs

Depressed, shallow respirations

Hypoactive bowel sounds

56
Q

Na+ values

A

135-145

57
Q

Hyponatremia extreme s/s

A

Seizures & coma
Tachycardia, weak thready pulse
Respiratory arrest

58
Q

Hypernatremia

A

Flushed, low grade fever, edema
Excess thirst
Dry tounge, nausea,

59
Q

K+ values

A

3.5 - 5

60
Q

Hypokalemia

A

Flat T waves, ST depression, prominent U-wave

Decreased DTRs, cramping, paralyzed limbs

Decreased motility, constipation, abdominal distention

61
Q

Hyperkalemia

A

ST elevation & peaked T-waves
Vfib or cardiac standstill, hypotension, bradycardia

Diarrhea, hyperactive bowel sounds

Paralysis in limbs, increased DTRs, profound muscle weakness

62
Q

Hyperventilation causes…

A

Respiratory Alkalosis

63
Q

Changes in what electrolyte can reduce the body’s response to cardiac drugs?

A

CA+

64
Q

Which 2 electrolytes work opposite of each other?

A

Ca+ and phosphate

65
Q

Hyperventilation increases which ABG factor?

A

pH

66
Q

Babinski’s sign

A

Hypomagnesemia

67
Q

Drug of choice for hyperaldosterone

A

Spironolactone

68
Q

Hyperventilation causes PCO2 to…

A

Increase

69
Q

What is Starling’s Law?

A

Starling’s Law states that extracellular fluids moves between body tissues based on differences in hydrostatic and osmotic/oncotic pressure.

70
Q

What is RAAS

A

Renin Angiotensin Aldosterone System

71
Q

What does Renin do?

A

Raise blood pressure

72
Q

What 3 things trigger Renin production?

A
  1. Decreased blood pressure
  2. Sympathetic Nervous system (fight or flight situations)
  3. Low sodium
73
Q

Respiratory Compensation

A

lungs correct pH imbalances by increasing or decreasing ventilation as needed.

74
Q

What changes with increased ventilation (compensation)

A

CO2 decreases -as CO2 is exhaled H+ ion concentration falls (raising pH)

75
Q

What changes with decreased ventilation (compensation)

A

CO2 is retained, buffer equation moves right, H+ increased and pH decreases

76
Q

Hyperventilation reduces/causes

A

CO2, which reduces H+ and raises pH (respiratory alkalosis)

77
Q

Hypoventilation causes retention of

A

CO2, which increases H+ and decreased pH

78
Q

Which two factors are effected in renal compensation?

A

H+ and HCO3-

79
Q

When does respiratory compensation occur?

A

To correct metabolic acid-base disturbances

80
Q

When does metabolic compensation occur?

A

To correct respiratory acid-base disturbances

81
Q

Hypercapnia

A

elevated PCO2 (greater than 45 mm Hg)

82
Q

Hypocapnia

A

diminished PCO2 (below 35) mm Hg

83
Q

Causes of Metabolic Acid-Base disturbance:

A

toxicity, diabetes, renal failure, excessive GI losses

84
Q

Causes of metabolic acidosis

A

increased production of acids other than CO2

DKA, prolonged diarrhea

85
Q

Causes of metabolic alkalosis

A

Excess base
retention of sodium bicarb or loss of H+

prolonged vomiting

86
Q

Normal respiratory rate

A

12-18 bpm

87
Q

If pH is abnormal is there compensation occurring?

A

No, if pH is abnormal is is uncompensated

88
Q

How does low albumin effect AG calculation?

A

It reduces the accuracy

89
Q

In what conditions do you see metabolic acidosis with elevated AG?

A

Lactic acidosis
Ketoacidosis
Renal failure
Overdose of ASA
Ingestion of methanol or ethylene glycol

90
Q

In what conditions do you see metabolic acidosis with normal AG?

A

GI loss of HCO3-
Increased renal HCO3- loss
Hypoaldosteronism
Ingestion of ammonium chloride
Hyperalimentation

91
Q

Side effects of hyperkalemia

A

dysrhythmias
cardiac arrest

92
Q

What electrolyte imbalance is often linked with acidosis?

A

Hyperkalemia

Hypercalcemia (secondary)

93
Q

What electrolyte imbalance is often linked with alkalosis?

A

Hypokalemia

hypocalcemia (secondary)

94
Q

Pulmonary causes of respiratory acidosis:

A

-COPD, asthma, emphysema
-Pulmonary edema
-Pneumonia
-Airway obstruction (laryngospasm, bronchospasm, aspiration)
-Underventilation by mechanical ventilation
-Hypoventilation secondary to obesity, postop pain, abdominal distention, or use of binders
-Excessive fatigue or weakness of rib cage muscles
-cystic fibrosis

95
Q

Non-Pulmonary causes of respiratory acidosis:

A

-Overdose of anesthetic, sedatives, and narcotics
-Neuromuscular disorders (Guilliain-Barre, myasthenia gravis, advanced MS)
-Spinal deformities
-CNS depression (cerebral infarct, meningitis, trauma)
-Cardiopulmonary arrest

96
Q

Pulmonary causes of respiratory alkalosis:

A
  • Pneumonia
  • Pulmonary edema
  • Pulmonary embolus
  • Asthma
  • Lung disease with shortness of breath (asthma, pneumonia, acute respiratory distress syndrome [ARDS], fibrosis, pulmonary embolism)
  • Hypoxia with hyperventilation
  • Overventilation by mechanical ventilation
97
Q

Non-pulmonary causes of respiratory alkalosis:

A
  • Anxiety
  • Pain
  • Liver disease
  • Fever/infection/sepsis
  • Central nervous system disorders (tumors, cerebrovascular accidents)
  • Salicylate intoxication
  • Alcohol intoxication
98
Q

Causes of Metabolic Acidosis with increased HCO3-:

A
  • Anxiety
  • Pain
  • Liver disease
  • Fever/infection/sepsis
  • Central nervous system disorders (tumors, cerebrovascular accidents)
  • Salicylate intoxication
  • Alcohol intoxication
99
Q

Causes of Metabolic Acidosis with decreased HCO3-:

A
  • Prolonged diarrhea
  • Renal tubular acidosis
  • Interstitial renal disease
  • Ureterosigmoid loop
  • Ingestion of acetazolamide or ammonium chloride
100
Q

Causes of metabolic alkalosis:

A
  • Bicarbonate ingestion
  • Excess IV sodium bicarbonate
  • Potassium-wasting diuretics
  • Loss of gastric fluids from vomiting, gastric suctioning, diarrhea, or binge–purge syndrome
  • Cushing’s syndrome
  • Primary hyperaldosteronism
  • Secondary hyperaldosteronism
101
Q

3 main buffer systems:

A
  1. protein
  2. phosphate
  3. carbonic acid-bicarbonate system
102
Q

During hypoventilation the lungs ________ CO2

A

retain

103
Q

During hyperventilation the lungs _____________ CO2

A

blow off

104
Q

Greater CO2 concentration = _______________ H+ concentration

A

greater

105
Q

Loss of HCO3- causes

A

metabolic acidosis

If uncompensated HCO3- will be lower than 22 and pH lower than 7.35

106
Q

Increased HCO3-

A

metabolic alkalosis

107
Q

How to treat respiratory acidosis

A

Treat the lung disorder for better ventilation.

Bronchodilation.

Antibiotics if pneumonia.

Intubation and mechanical ventilation if needed.

108
Q

How to treat respiratory alkalosis

A

Slow the breathing rate;

CO2 rebreather.

Patient may need sedative.

109
Q

How to treat metabolic acidosis

A

Sodium bicarbonate IV.

Treat etiologic disorder (for example, if DKA, treat diabetes).

110
Q

How to treat metabolic alkalosis

A

IV acetazolamide.

111
Q

Physical findings of metabolic alkalosis

A

Chvostek’s sign.

Trousseau’s sign.

Hypotension or hypertension may be present. Patients with bulimia often have erosions of teeth enamel and dental caries.

112
Q

Physical findings of metabolic acidosis

A

Tachycardia.

Hypotension, weak pulses.

Dehydration signs may be present: dry mucous membranes, poor skin turgor, and delayed capillary refill.

Patients with DKA may present with fruity odor to their breath. Metabolic acidosis can also cause confusion, lethargy, and possibly coma or seizures.

113
Q

Physical findings of respiratory alkalosis

A

High respiratory rate.

Tachycardia.

114
Q

Physical findings of respiratory acidosis

A

Diminished respiratory rate.

Cyanosis.

Clubbing if chronic hypoxia

115
Q

How does the RAAS result in increased blood volume and increased blood pressure

A

Renin is released from the kidney in response to decreased renal perfusion (caused by hypotension, hypovolemia, dehydration, low cardiac output). It cleaves to angiotensinogen (protein produced in the liver) to produce angiotensin I. ACE converts this to angiotensin II in the lungs. Angiotensin II is a powerful vasoconstrictor, it binds to receptors in the adrenal cortex, which stimulates aldosterone production. Aldosterone increases Na and H2O reabsorption in the blood and excretion of potassium through the urine. The increased volume of blood thus helps to increase blood pressure.

116
Q

What is the most significant direct effect of aldosterone release?

A

reabsorption of sodium in kidney tubules

117
Q

Angiotensinogen is constantly produced by the __________

A

liver

118
Q

Of the three buffering mechanisms in the body which is the strongest?

A

renal

119
Q

Metabolic acidosis with an elevated AG is found in:

A
  • Lactic acidosis
  • Ketoacidosis
  • Renal failure
  • Overdose of acetylsalicylic acid (ASA), also known as aspirin
  • Ingestion of methanol or ethylene glycol
120
Q
A

Patho (14 decks)

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