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Lab D > Lab 2 - Isohydria: Acid-base balance, gasometry > Flashcards

Lab 2 - Isohydria: Acid-base balance, gasometry Flashcards

1
Q

What can acid-base disturbances signifficantly impact?

A

case morbidity and mortality

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2
Q

What is isohydria

A

The concentration of H+ ions in the blood

PH= -log10 H+

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3
Q

What is the stability of isohydria essential for

A

Cell membranes and enzyme activity

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4
Q

What can a change in PH result in

A

electrolyte imbalance,

change in muscle irritability too

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5
Q

Why is intracellular and extracellular buffers importaint

A

If the rate of H+ production is too rapid for elimination for the body

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6
Q

What is the function of the buffer solution

A

It can resist PH changes

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7
Q

What is the most importaint physicochemical buffer system in all fluid compartments?

A

Carbonic acid - bicarbonate system

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8
Q

Besides Carbonic acid - bicarbonate system, what are the other systems

A

Primary - Seccondary phosphate system

Protein-Proteinate buffer system

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9
Q

What form the vital buffer system

A

Lungs and kindey

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10
Q

How does the lung regulate the PH acticity

A

by retaining or excreeting CO2

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11
Q

What happens with the equation in the lung when the `H+ is increased

A

Equation moves to the left generating extra CO2

Leading to hypercapnia stimulating the ventilation and lungs can eliminate the CO2

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12
Q

The capacity to retain CO2 is limited

True or False

A

True

Because of oxygen demand

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13
Q

Pulmonary capacity to excrete CO2 is low

A

False

The Pulmonary capacity to excrete CO2 is it’s HUGE

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14
Q

What is Kussmaul breathing

A

Normal frequency, but very deep inspiration and expiration

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15
Q

The kidneys can excrete or retain CO2

True or false

A

False
The kidney can excrete or retain H+
and also regenerate HCO3- via Complex tubular mechanism

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16
Q

How does the kidney regenerate HCO3-

A

via Complex tubular mechanism

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17
Q

How long does it take for the complex tubular mechanism to regenerate HCO3-

A

Long time

Hours to days

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18
Q

If the CO2 levels in the body increase, what happens with the EQUATION due to kidney buffer system

A

The equation will push to the RIGHT

- Produce excess H+ and HCO3- and then H+ can be eliminated by the KIDNEY

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19
Q

Acid-Base evaluation is a routine test in emergency patients. True or false

A

True

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20
Q

What can the acid-base status tell us something about

A

Function of the VITAL BUFFER SYSTEMS

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21
Q

The acid-base analyzers are simple test not complex

true or false

A

False

They are complex devices

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22
Q

What does the acid-base analyzers measure

A 
blood-gas parameters
electrolytes
hemoglobin
haemaocrit
lactate
glucose etc
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23
Q

Venous blood is essential for assessment of the RESPIRATORY function
True or false

A

False

Arterial blood is ssential for assesment of the respiratory function

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24
Q

Both arterial and venous sample provide usefull information about the metabolic state on the animal
True or false

A

True

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25
Q

You must avoid air contamination of the samples

True or false

A

True

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26
Q

Astrup-technique is a CO2 retaining method

A

False

Its a method to prevent air contamination of the sample

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27
Q

What will be present in aircontaminated samples

A

Increased pO2

Note 150 mmHg pO2 in athmospheric air

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28
Q

CO2 will evaporate into the air shortly after sampling, the pCO2 may be DECREASED
True or false

A

True

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29
Q

When sampling anticoagulated blood should be used

True or false

A

True

Ca-equilibrated Li-Heparanized syringe

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30
Q

In case of longer storage of sample the pCO2 will be increased
True or false

A

True

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31
Q

How long can you store the sample in room temperature

A

No more than 5-10min

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32
Q

How long can you store the sample in the refrigerator (0-4 degree)

A

Not more than 30min

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33
Q

How do you measure PH and CO2

A

By Analyzers utilze ion selective electrodes (ISE)

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34
Q

At which temp are the samples analysed under?

A

37 degrees

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35
Q

The soluibility of gasses are dependent on temseratuse

True or false

A

True

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36
Q

The measured values need to be corrected to the temperature of the patient
True or false

A

True

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37
Q

Actual PH in blood

A

Ph 7,35-7,45

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38
Q

Partial pressure

pCO2

A

Respiratory Parameter
40mmHg
(35-45)

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39
Q

Standard Bicarbonate concentration

HCO3- mmol/L

A

Metabolic Parameter
21-24 mmol/L

Bicarbonate conc of plasma, if the blood is equlibrated to 40mmHg pCO2 on 37 degrees its value depends on pCO2

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40
Q

Actual Base excess (ABE) (demand) or residue (mmol/L)

A

Metabolic Parameter
+-3,5 mmol/L
Titratable acidity or basicity - the amount of acid or base needed to equlibrate blood to PH 7,4 (pCO2 is stabilized at 40 mmHg/l on 37 degrees)

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41
Q

TCO2

Total CO2 concentration in plasma (mmol/L)

A

23-30 mmol/L

CO2 content of blood liberated by strong acid.

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42
Q

TCO2 is 10% higher than plasma HCO3-

True or false

A

False

TCO2 is 5% higher than plasma HCO3-

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43
Q

TCO2 gives no direct information about respiratory function.

True or false

A

True

TCO2 gives no direct information about respiratory function.

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44
Q

TCO2 may be ignored when HCO3- result is pressent

True or false

A

True

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45
Q

PH in blood during acidosis

A

<7,4

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46
Q

PH in blood during alkalosis

A

> 7,4

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47
Q

At which PH value is the Acidaemia decompensated

A

At PH <7,35,the Acidaemia is decompensated

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48
Q

At which PH value is Alkalaemia decompensated

A

At PH >7,45, the Alkalaemia is decompensated

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49
Q

What is step one in Acid-Base state analysis

A

Evaluate wheter Acidaemia (acidosis) or Alkalaemia (Alkalosis) is present

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50
Q

What is the blood PH referece range

A

Between 7,35-7,45

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51
Q

What does compensated/decompensated mean

A

Indications of the outcome, the effectiveness of all processes together - regardless of whether or not we see compensatory effort

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52
Q

Step 1 in evaluation of ABB state must not be omitted(excluded) because the shift of the other parameters are compared to the PH change
True or false

A

True

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53
Q

What is step 2 in AB state investigations

A

Search for the Cause = PRIMARY PROCESS of the alteration of the observed PH alteration

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54
Q

Acidaemia and alkalemia can occur due to metabolic or respiratory changes
True or false

A

True

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55
Q

Predominant change of pCO2 reffers primarly to

A

Respiratory proceses

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56
Q

Predominant change of HCO3- and ABE refers primarly to

A

Metabolic processes

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57
Q

Respiratory background
In case of pCO2 show a strong shift in the opposite direction as PH
True or False

A

False

In case of pCO2 show a strong shift in the same direction as PH

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58
Q

Respiratory background

What happens when pCO2 is >40mmHg

A

More of it binds to water and forms carbonic acid

59
Q

Respiratory background

Increased pCO2 can be called a shift in alkaloid direction

A

False

Increased pCO2 result in acidic direction

60
Q

Respiratory background

In situations of impared gass exhange, the ramaining high CO2 forms? and lead to?

A

Carbonic acid

Shifts PH to acidosis = RESPIRATORY ACIDOSIS

61
Q

Respiratory background

When does respiratory alkaloisis happen? Exsample

A

When hyperventilation is pressent - to mutch CO2 is exhaled = causes elevation of the PH = RESPIRATORY ALKALOISIS

62
Q

Metabolic background

A

When the PH alteration is caused by a metabolic process or kidney malfunction

63
Q

Metabolic background

Metabolic parameters is

A

HCO3- and ABE

64
Q

Metabolic background

In case of Lactic acid production what will occur

A

Metabolic acidosis

Both metabolic parameters are shifted to acidic direction

65
Q

Metabolic background

What is actual base excess

A

It is a calculated parameter which has a defined aid correction of acid base disturbances

In alkalosis - Parameter shifts from 0 to positive range= in the lack of acids.

66
Q

Negative base excess means

A

a lack of base

67
Q

Always evaluate wheter the change (resp and metab) parameter respond to ………..

A

The alteration of PH

68
Q

The primary process is the one that leads to the acid-base disturbance = This parameter is always shifted in the SAME direction as the PH and usually this shift is significant
True or false

A

True

69
Q

When can you detect compensatory effects

A

When the shift switches in the oposite direction compared to PH

70
Q

If all parameters shift in the same direction as the PH

A

Primary process shows signifficantly bigger shift

71
Q

What i s characterized as a bigger shift

A

25-30% more than normal value

72
Q

What is mixed acidosis

A

All parameters shifted in same direction as PH - mostly seen in advance acidosis

73
Q

What is step 3 in AB state evaluation

A

Evaluate wheter compensation effort is visuable in the result or not

74
Q

If either respiratory or metabolic parameters is shifted in the opposite direction than the PH - what will happen

A

Compensatory effect is visuable

75
Q

What happens due to Compensatory effect in metabolic acidosis in the lung

A

Lungs try to compensate by highly effective gas exchange
= Very deep breath and longer gas exchange
= Kussmaul breathing
= excretion of lots of CO2 - PH is acidic and CO2 changes in alkaline direction

76
Q

What is step 4 in AB state evaluation

A

Give an example what can cause the established changes

77
Q

Metabolic acidaemia/Acidosis
PH
HCO3-
BE

A

<7,4

<20mml/L

78
Q

Metabolic acidaemia/Acidosis

Causes

A
  1. HCO3- loss:

2. Increased acid intake:

79
Q

Metabolic acidaemia/Acidosis

Causes of HCO3 loss

A

diarrhoea
Ileus
kidney tubular disturbances

80
Q

Metabolic acidaemia/Acidosis

Causes of Increased acid intake:

A

Increased acid intake:

  • Fruits
  • too acidic silage
  • overdose of acidifying drugs (ammonium chloride, vit C)
  • Increased acid production - lactic acid prod due to anaerobic glycolysis, frequent in anorectic, weak animals
  • In cattle - grain overdose, leading to volatile acid production.
  • Increased ketogenesis, leading to ketosis due to relative or objective starvation or DIABETES MELLITUS
  • Decreased acid excretion: RENAL FAILURE
  • Ion exchange: HYPER KALAEMIA (H/K PUMP)
  • Some Xenobiotic- ethylene-glycol toxicosis:
    Metabolites are acidic molecules leading to metabolic acidosis and finally remal failure will worsen it
81
Q

What are the effects of Metabolic acidaemia/Acidosis

A
  1. Kussmaul breathing = hyperventilation (not panting)
  2. Hypercalcaemia - increased mobilation from bones in case of long term acidosis.
  3. Vomiting, depression
  4. Hyperkalaemia: decreased cardiac muscle activity.
    SA, AV block, Bradycardia
  5. in urine- titrable acidity increases(not process of renal origin)
82
Q

Treatment of Metabolic acidaemia/Acidosis

A

Providing adequate ventilation
If PH <7,2 = Infusion therapy involving alkaline fluid
(amount is calculated by using ABE)

83
Q

Treatment of Metabolic acidaemia/Acidosis

ABE formula

A

Required amount of base (mmol) = ABEBwtK
K is a coeffesient
K in small animals: 0,3
K in large animals: 0,2

Half of amount given first
1-2 hours control = is the other half nessessary

84
Q

Treatment of Metabolic acidaemia/Acidosis
ABE formula - Half of the calculated amount shold be given first
True or false

A

True

85
Q

What is the anion gap

A

The anion gap is a usefull parameter when attempting to determine the cause of metabolic acidaemia

86
Q

The anion gap describes the difference between the….

A

Commonly measured cations in plasma, and the commonly measured anions

87
Q

How do you maintain the electronneutrallity

A

By keeing the concentration of cations and anions equal in the plasma

88
Q

Unmeasured cations (UC+) include

A
  1. Proteins that are positively charged + at physiologic ph

2. Free or ionized forms of calcium (Ca2+) and magnesium (Mg2+) (Not seen in high concentration)

89
Q

Unmeasuref anions (UA-) include

A
  1. Proteins that are negatively charged - at physiologic ph (Albumin mostly)
  2. Acids that are produced during physiologic and pathologic processes. (Lactate, Phosphates, Sulphates and ketones)
  3. Some toxins and drugs: Methanol, salicylate, ethylene glycol.
90
Q

UA- are found in lower concentration and are therefore hasn’t got a great impact on the anion gap
True or false

A

False

They are found in higer concentration and has a greater impact on the anion gap.

91
Q

What is the reference range for anion gap

A

8-16mmol/L

92
Q

Why is the anion gap usefull for us to determine

A

Because its useful to determine wheter metabolic acidaemia is due to primary HCO3- loss or accumulation of organic acids

93
Q

To maintain electronneutrality, how do youbalance a decrease in HCO3-

A

By an increase of Cl- or UA-. If CL- replaces the HCO3- it usually happen due to direct HCO3- loss (eg. Diarrhoea), the anion gap will be normal.

= Hyperchloraemic metabolic acidose

94
Q

What happens if the reduction of HCO3- is due to accumulation of UA- (lactate, bhb)

A

The Cl- stays normal

= Normochloraemic metabolic acidosis.

95
Q

Name cases of NORMAL ANION GAP

HYPERCHLORAEMIC

A
  1. Diarrhoea (HCO3- loss)
  2. Early kidney failure
    (H+ retention, decreased ammonia excretion)
  3. Renal tubular acidosis
    (Proximal (FANCONI SYNDROME) or distal tubular effect)
  4. Acidifying substances (NH4Cl)
96
Q

Name cases of INCREASED ANION GAP

NORMOCHLORAEMIC

A
  1. Azotaemia or uraemia
    ( Advanced kidney failure - organic acid accumulation)
  2. Lactacidosis
    (Shock, hypovolaemia, poor tissue perfusion, tissue necrosis)
  3. Ketoacidosis
    ( Diabetic ketoacidosis - increased hepatic production of ketone bodies)
  4. Toxicosis
    (Ethylene gycol toxicosis - also alcohol)
97
Q

Metabolic alkalemia/ alkalosis
PH
HCO3-
BE

A

PH >7,4
HCO3- >28mmol/l
BE >+3,5mmol//L

98
Q

Metabolic alkalemia/ alkalosis

Causes

A
  1. Increased allkaline intake
    = Overdose of bicarbonate, or feeding rotten food
  2. Increased ruminal alkaline production
    = High protein intake, Low carbohydrate intake, anorexa, hypomotility
  3. Decreased hepatic ammonia catabolism (liver failure)
  4. Increased acid loss
    = vomiting, gastric dilation volvulus syndrome, abomasal displacement
  5. Ion exchange
    = hypokalemia - due to henle loop diuretics remember H+/K+ pump.
    (Paradoxical aciduria)
99
Q

Metabolic alkalemia/ alkalosis

Effects

A
  1. Breathing depression (compensory resp. acidosis)
    - low breathing rate - hypoventilation
  2. Muscle weakness - hypokalemia
  3. Hypocalcaemia due to increased Ca2+ bindings of ALBUMIN
  4. Ammonia toxicosis
  5. Arryhtmia, biphasic P, QT increase (AV conduction disorder), Flat T, U wave
  6. Paradoxical aciduria
100
Q

Metabolic alkalemia/ alkalosis

Treatment

A

In general its enough to treat the underlying electrolyte imbalance

101
Q

Respiratory acidaemia/acidosis
PH
pCO2
PO2

A 
PH = <7,4
pCO2 = 40 mmHg
pO2 = <40mmHg
102
Q

Respiratory acidaemia/acidosis

Causes

A
  1. Upper airway obstruction
  2. Pleural cavity disease, PNEUMOTHORAX
  3. Pulmonary disease: SEVERE PNEUMONIA, PULMONARY OEDEMA, DIFFUSE LUNG METASTASIS, PULMONARY THROMBOEMBOLISM
  4. Depression of central control of respiration
    DRUGS, TOXINS, BRAINSTEM DISEASE
  5. Neuromuscular depression of respiratory muscles
  6. Muscle weakness, eg. muscle weakness in hypokalemia
  7. Cardiopulmonary arrest
103
Q

Respiratory acidaemia/acidosis

Effects

A
  1. DYSPNOEA
  2. CYANOSIS
  3. SUFFOCATION
  4. MUSCLE WEAKNES
  5. TIREDNESS
104
Q

Respiratory acidaemia/acidosis

Treatment

A
  1. Assisting the ventilation - providing fresh air or oxygen therapy
  2. Treatment of the cause - eg
    - DIURETIC treatment in case of fluid accumulation in the lung, PULMONARY OEDEMA,
  • Specific cardiologic treatment, in case of underlying cardiac diseases
  • Treatment of pneumonia= removal of fluid from plural space etc.
105
Q

Respiratory acidaemia/acidosis
Treatment

Mildly anxiolytic/sedationg drugs to decrease the fear and excitement of animals caused by hypoxia

True or false

A

True

106
Q

Respiratory alkalaemia/alkalosis
PH
pCO2
PO2

A

PH >7,4
pCO2 < 40 mmHg
pO2 > 40 mmHg

107
Q

Respiratory alkalaemia/alkalosis

Causes

A
  1. Increased loss of CO2 = HYPERVENTILATION
    - Excitation
    - Forced ventilation (anaesthesia)
    - Epileptiforme seizures
    - Fever, hyperthermia
    - Intertitial lung disease
108
Q

Respiratory alkalaemia/alkalosis

Effects

A
  1. Hyperoxia, the decreased pCO2 : pO2 ratio may lead to APNOEA
  2. Increased elimination of HCO3- by the KIDNEYS
109
Q

Respiratory alkalaemia/alkalosis

Treatment

A
  1. Anxiolytic or mild sedative drug in case of HYPEREXCITATION
    It is important to increase the pCO2 level by closing the nose or nostrils until breathing normalises (only few min)
110
Q

Blood gas analysis is performed to ………

A

Assess effectiveness of gas exchange

= Ventilation in the lung during anaesthesia or dyspnoea

111
Q

Sample and sampling for Blood Gas analysis

Where to take samples from

A

Arterial blood because it’s essential for PRECICE assessment of respiratory FUNCTION
= How effective the gas exchange is in the alveoli

112
Q

What does venous blood gas analysis reflect

A

How mutch oxygen that is consumed by the body

113
Q

It is not necessary to use antigoagulated blood when performing blood gas analysis

True or False

A

FALSE

We use anticoagulated blood
Ca-equilibrated Li-heparinised plasma, preheparinized syringe

114
Q

Which sampling method shall be used when performing blood gas analysis

A

The Astrup-technique

- Closed sampling method

115
Q

Why must the blood gas sample be stored with no air/vacum space

A

Because CO2 can evaporate

Air contamination causes false increased pO2 pressure

116
Q

How long can you store the sample before measuring

A

Within 15min or place on ice to minimize changes in blood gas PARTIAL PRESSURE as a result of continuous metabolism

117
Q

The blood gas analyses….

A

Directly the pCO2 and pO2 with the iron spesific electrodes (ISE)

118
Q

In which condition are the samples investigated under

A

Standarized temp 37 degrees

119
Q

The dissociation of gasses is independent of temp

True or false

A

False

Both standard 37 degrees and the patient temp has to be accounted for

120
Q

Parameters and refferance ranges

pO2 - Partial pressure of oxygen

A

Indicates the ability of the lung to oxygenate blood
Arterial= 88-118 mmHg
Venous= 35-45 mmHg

121
Q

Parameters and refferance ranges

pCO2 - Partial pressure of carbon dioxide

A

Indicates the ability of the alveolar gas exchange to remove the CO2.

It is directly proportional to the rate of CO2 production, and inversely proportional to alveolar ventilation
Arterial = 35-45 mmHg
Venous = 35-45 mmHg

122
Q

Parameters and refferance ranges
Oxygen saturation
SAT or SatO2

A 
Oxygen saturation (%)= Calculated from Hb and pO2
Indicates the fraction of oxygen-saturated hemoglobin relative to total hemoglobin in the blood
Arterial= 90-100%
Venous= 70-80%
123
Q

Parameters and refferance ranges
FiO2
Fraction of inspired oxygen

A

Is the assumed % of O2 concentration participating in gas exchange in the alveoli

Room air= 0,209 = 20.9%
O2 enriched= 0,21-1,0
>0,5 risk of O2 toxicity

124
Q

What is the most importaint parameter to access the gas exchange capacity in animals

A

paO2 and paCO2

125
Q

Overall effectiveness of gass exchange are catherorized into 3 groups

A 
Normventilation 
- Arterial= 80-110 mmHg in room air
- 
Hypoventilation <60 mmHG
Hyperventilation - for CO2 hypocapnia or hypercapnia are used
126
Q

Oxygen saturation value in room air

A

97-100%

127
Q

Partial oxygen pressure under 40-50 mmHg - what could be visuable

A

Cyanosis

128
Q

Hypoventilation

pCO2

A

> 45 mmHg (most reliable in arterial blood)

129
Q

Hypoventilation
Hypoxemia depends on the degree of hypercapnea, and the FiO2
True or false

A

True

130
Q

Hypoventilation

Low O2 saturation depends on

A

Blood Hb concentration, RBC cound

131
Q

Hypoventilation

A

pCO2
Hypoxemia
Low O2 saturation

132
Q

Hypoventilation causes

A
  1. Upper airway obstruction
  2. pleural effusion
  3. drugs or disorders affecting central control of respiration = general anesthesia
  4. Neuromuscular diseases (reacts on muscle and respiratory system, eg. HYPOKALAEMIA)
  5. Overcompensation of metabolic alkalosis
133
Q

Hypoventilation Effects

A

Dyspnoea

Cyanosis

134
Q

Hypoventilation treatment

A
  1. Assisting ventilation eg. assisted breathing, oxygen treatment
  2. Diurethic treatment - incase of fluid accumulation in lungs, pulmonary oedema> or in the thoracic cavity
  3. Mildly anxiolytic/ sedating treatment
135
Q

Additional to hypoventilation, arterial blood gas tensions are also influenced by

A

Ventilation perfusion missmatch (VA/Q)

136
Q

Ventilation perfusion missmatch

  1. Normal ventilation
  2. Inadequate ventilation
A
  1. Normal ventilation with inadequate perfusion
    blood passes alveoli for oxygen= EMBIOLA, HEART INSUFFIENCY
  2. Inadequate ventilation with normal perfusion
    ventilation of alveoli doesn’t allow enough oxygen
137
Q

Hyperventilation

PaCO2

A

<35 mmHg

138
Q

Hyperventilation
Hyperoxaemia is usually present together with decreased SAT
True or false

A

False

Hyperoxaemia is usually present together with INcreased SAT

139
Q

Hyperventilation

Causes

A
  1. Iatrogen
    = Forced ventilation during anesthesia (high FiO2)
  2. Seizures, epilepsy
  3. Excitation
    (mild=frequently visiting vet. Extreme= shock after accident)
  4. Compensation of severe metabolic acidosis
    = Kussmaul breathing
140
Q

Hyperventilation
Venous samples should not be used to assess directly gas exchange
True or false

A

True

141
Q

Hyperventilation

What does oxygen saturation inform us about

A

It informs about tissue O2 usage

142
Q

Hyperventilation

When does ISCHEMIC reaction occur

A

Venous saturation below 60% indicates that the body is in lack of oxygen

143
Q

IMPORTAINT

acid-base or blood gas analyzers regardless which name we use include……

A
  1. ISE for pH, CO2, HCO3-
  2. Ions: Ca2+, Na+, K+, Cl-

WHen we interpret, all 3 barameters should be considered

  • ACID BASE PARAMETER
  • BLOOD GAS ANALYSIS
  • INOGRAM

Lab D (11 decks)

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