Homeostasis Flashcards
1
Q
Respiratory Acidosis
A
Retention of CO2, low pH
(Compromised gas exchange on lungs-COPD, infection, asthma)
2
Q
H+
A
Hydrogen
very strong acid
decreased pH
3
Q
What causes metabolic Acid-Base Disturbances
A
Toxicity, diabetes, renal failure, excessive GI losses
4
Q
Metabolic Acidosis
A
Result from increased production of acids other than CO2 (DKA)
5
Q
Metabolic Alkalosis can be caused by:
A
Excess base, retention of Bicarb or prolonged vomiting
6
Q
How to tell if it’s respiratory
A
PH and PCO2 move in opposite directions
7
Q
How to tell if it’s metabolic
A
PCO2 is normal or moving in the same direction as pH
8
Q
What happens during DKA?
A
Anion gap increases
HCO3 level decreases
9
Q
How do the kidneys compensate for alkalosis?
A
Retaining H+ and excreting HCO3
10
Q
Which electrolyte imbalance leads to Trousseau’s sign?
A
Hypocalcemia
11
Q
What results when the kidneys excrete bicarb?
A
Acidosis
12
Q
Hypokalemia can cause what complications with digitalis?
A
Dig toxicity
13
Q
What does hyperventilation cause related to PCO2?
A
Increased PCO2
14
Q
Low concentration of H+ is…
A
Low pH
15
Q
Low pH is…
A
Acidic
16
Q
Low concentration of H+ is…
A
Basic (alkaline)
17
Q
Normal pH
A
7.35-7.45
18
Q
PCO2
A
35-45 mm Hg
19
Q
PO2
A
90-100 mm Hg
20
Q
Normal HCO3-
A
22 to 26mEq/L
21
Q
SaO2
A
85-100%
22
Q
What are the 3 buffer systems?
A
Proteins
Phosphates
Carbonic acid-bicarb system
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
24
Q
Bicarbonate
A
HCO3-
Normal value 22-26
25
We can convert CO2 to...
Bicarbonate and H+
26
We can convert bicarbonate and H+ to...
H+ and CO2
27
The level of CO2 relates directly to the level of...
H+
28
More CO2 = _______ hydrogen
Less CO2 = ________ hydrogen
More/Less
29
ABGs
pH high
CO2 high
saME MEtabolic (Metabolic Alkalosis)
30
ABGs
pH low
CO2 low
saME MEtabolic (Metabolic Acidosis)
31
ABGs
pH high
CO2 low
REverse REspiratoy (Respiratory Alkalosis)
32
ABGs
pH low
CO2 high
REverse REspiratoy (Respiratory Acidosis)
33
Anion Gap
Normal metabolic parameter;
figured by subtracting anions from cations (negatives from positives)
34
2 cations
positively charged ions
K+
Na+
35
2 anions
negatively charged ions
Cl-
HCO3-
36
Normal K+ range
3.5-5.2
37
Normal Na+ range
135-145
38
Normal Cl- range
96-106
39
Normal HCO3- range
22 to 26
40
Normal cation range
138.5 - 150.2 mEq/L
41
Normal anion range
118 - 132
42
Anion Gap
Difference of cations minus anions
Normal value 8-16
43
Anion Gap
Less HCO3- means _________ gap
Bigger
44
Metabolic Acidosis with an INcreased AG is found in;
Lactic acid
Ketoacidosis
Renal failure
Overdose of ASA
Indigestion of methanol or ethylene
45
Metabolic Acidosis with NORMAL AG found in:
GI loss of HCO3-
Increased renal HCO3- loss
Hypoaldosteronism
Ingestion of ammonium chloride
Hyperalimentation
46
K+ normal values
3.5 - 5
47
Hyperkalemia
Heart- Tight and Contracted
ST elevation, V Fib,
hypotension, bradycardia
GI - Tight and Contracted
Diarrhea, hyperactive bowel
Neuromuscular
Paralysis in extremities, increased DTRs
48
Hypokalemia S/S
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
49
Hypocalcemia Strong B's
Bones
Blood
Beats
50
Ca+ lab values
8 - 10.5
51
Hypocalcemia s/s
Trousseau's sign
Chvosteck"s
Diarrhea
Circumoral Tingling
52
Hypercalcemia
Swollen and Slow - moans, groans, & stones
Constipation
Bone pain
Stones
Decreased DTRs
53
Mag levels
1.3 - 2.1
54
Hypomagnesemia
s/s
EKG-ST depression, T wave inversion, Vfib, tachycardia
Hypereflexia, increased DTRs
Nystagmus
Diarrhea
55
Hypermagnesemia
Prolonged PR intervals, heart block
Hyporeflexia-increased DTRs
Depressed, shallow respirations
Hypoactive bowel sounds
56
Na+ values
135-145
57
Hyponatremia extreme s/s
Seizures & coma
Tachycardia, weak thready pulse
Respiratory arrest
58
Hypernatremia
Flushed, low grade fever, edema
Excess thirst
Dry tounge, nausea,
59
K+ values
3.5 - 5
60
Hypokalemia
Flat T waves, ST depression, prominent U-wave
Decreased DTRs, cramping, paralyzed limbs
Decreased motility, constipation, abdominal distention
61
Hyperkalemia
ST elevation & peaked T-waves
Vfib or cardiac standstill, hypotension, bradycardia
Diarrhea, hyperactive bowel sounds
Paralysis in limbs, increased DTRs, profound muscle weakness
62
Hyperventilation causes...
Respiratory Alkalosis
63
Changes in what electrolyte can reduce the body's response to cardiac drugs?
CA+
64
Which 2 electrolytes work opposite of each other?
Ca+ and phosphate
65
Hyperventilation increases which ABG factor?
pH
66
Babinski's sign
Hypomagnesemia
67
Drug of choice for hyperaldosterone
Spironolactone
68
Hyperventilation causes PCO2 to...
Increase
69
What is Starling's Law?
Starling's Law states that extracellular fluids moves between body tissues based on differences in hydrostatic and osmotic/oncotic pressure.
70
What is RAAS
Renin Angiotensin Aldosterone System
71
What does Renin do?
Raise blood pressure
72
What 3 things trigger Renin production?
1. Decreased blood pressure
2. Sympathetic Nervous system (fight or flight situations)
3. Low sodium
73
Respiratory Compensation
lungs correct pH imbalances by increasing or decreasing ventilation as needed.
74
What changes with increased ventilation (compensation)
CO2 decreases -as CO2 is exhaled H+ ion concentration falls (raising pH)
75
What changes with decreased ventilation (compensation)
CO2 is retained, buffer equation moves right, H+ increased and pH decreases
76
Hyperventilation reduces/causes
CO2, which reduces H+ and raises pH (respiratory alkalosis)
77
Hypoventilation causes retention of
CO2, which increases H+ and decreased pH
78
Which two factors are effected in renal compensation?
H+ and HCO3-
79
When does respiratory compensation occur?
To correct metabolic acid-base disturbances
80
When does metabolic compensation occur?
To correct respiratory acid-base disturbances
81
Hypercapnia
elevated PCO2 (greater than 45 mm Hg)
82
Hypocapnia
diminished PCO2 (below 35) mm Hg
83
Causes of Metabolic Acid-Base disturbance:
toxicity, diabetes, renal failure, excessive GI losses
84
Causes of metabolic acidosis
increased production of acids other than CO2
DKA, prolonged diarrhea
85
Causes of metabolic alkalosis
Excess base
retention of sodium bicarb or loss of H+
prolonged vomiting
86
Normal respiratory rate
12-18 bpm
87
If pH is abnormal is there compensation occurring?
No, if pH is abnormal is is uncompensated
88
How does low albumin effect AG calculation?
It reduces the accuracy
89
In what conditions do you see metabolic acidosis with elevated AG?
Lactic acidosis
Ketoacidosis
Renal failure
Overdose of ASA
Ingestion of methanol or ethylene glycol
90
In what conditions do you see metabolic acidosis with normal AG?
GI loss of HCO3-
Increased renal HCO3- loss
Hypoaldosteronism
Ingestion of ammonium chloride
Hyperalimentation
91
Side effects of hyperkalemia
dysrhythmias
cardiac arrest
92
What electrolyte imbalance is often linked with acidosis?
Hyperkalemia
Hypercalcemia (secondary)
93
What electrolyte imbalance is often linked with alkalosis?
Hypokalemia
hypocalcemia (secondary)
94
Pulmonary causes of respiratory acidosis:
-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
Non-Pulmonary causes of respiratory acidosis:
-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
Pulmonary causes of respiratory alkalosis:
* 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
Non-pulmonary causes of respiratory alkalosis:
* Anxiety
* Pain
* Liver disease
* Fever/infection/sepsis
* Central nervous system disorders (tumors, cerebrovascular accidents)
* Salicylate intoxication
* Alcohol intoxication
98
Causes of Metabolic Acidosis with increased HCO3-:
* Anxiety
* Pain
* Liver disease
* Fever/infection/sepsis
* Central nervous system disorders (tumors, cerebrovascular accidents)
* Salicylate intoxication
* Alcohol intoxication
99
Causes of Metabolic Acidosis with decreased HCO3-:
* Prolonged diarrhea
* Renal tubular acidosis
* Interstitial renal disease
* Ureterosigmoid loop
* Ingestion of acetazolamide or ammonium chloride
100
Causes of metabolic alkalosis:
* 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
3 main buffer systems:
1. protein
2. phosphate
3. carbonic acid-bicarbonate system
102
During hypoventilation the lungs ________ CO2
retain
103
During hyperventilation the lungs _____________ CO2
blow off
104
Greater CO2 concentration = _______________ H+ concentration
greater
105
Loss of HCO3- causes
metabolic acidosis
If uncompensated HCO3- will be lower than 22 and pH lower than 7.35
106
Increased HCO3-
metabolic alkalosis
107
How to treat respiratory acidosis
Treat the lung disorder for better ventilation.
Bronchodilation.
Antibiotics if pneumonia.
Intubation and mechanical ventilation if needed.
108
How to treat respiratory alkalosis
Slow the breathing rate;
CO2 rebreather.
Patient may need sedative.
109
How to treat metabolic acidosis
Sodium bicarbonate IV.
Treat etiologic disorder (for example, if DKA, treat diabetes).
110
How to treat metabolic alkalosis
IV acetazolamide.
111
Physical findings of metabolic alkalosis
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
Physical findings of metabolic acidosis
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
Physical findings of respiratory alkalosis
High respiratory rate.
Tachycardia.
114
Physical findings of respiratory acidosis
Diminished respiratory rate.
Cyanosis.
Clubbing if chronic hypoxia
115
How does the RAAS result in increased blood volume and increased blood pressure
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
What is the most significant direct effect of aldosterone release?
reabsorption of sodium in kidney tubules
117
Angiotensinogen is constantly produced by the __________
liver
118
Of the three buffering mechanisms in the body which is the strongest?
renal
119
Metabolic acidosis with an elevated AG is found in:
* Lactic acidosis
* Ketoacidosis
* Renal failure
* Overdose of acetylsalicylic acid (ASA), also known as aspirin
* Ingestion of methanol or ethylene glycol
120
