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Y2 - Resp > Lecture 5 - CO2 In Blood > Flashcards

Lecture 5 - CO2 In Blood Flashcards

1
Q

What is myalgia?

A

Muscle aches

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2
Q

What are diffuse rhonchi?

A

Breathing sounds that are non specific cracking sounds

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3
Q

What signs may you see on a chest x-ray with someone who has Covid-19 Pneumonia?

A

Wides spread fluffy shadows

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4
Q

How do widespread fluffy shadows appear on a CT scan in someone with pneumonia COVID 19?

A

White in cross section
Called ground glass opacities

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5
Q

What tests would you order for a patient who you consider to have Covid-19 Pneumonia?

A

ECG
FBC
U+E
Crp
Arterial Blood Gas (ABG)
Urinalysis

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6
Q

What condition would you be worrying about if someone had very high levels of Glucose and Ketones in their urine?

A

Diabetic ketoacidosis

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7
Q

What is the normal pH range for blood plasma?

A

7.35-7.45

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8
Q

How do you treat Diabetic Ketoacidosis?

A

Give insulin

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9
Q

What dangerous condition can develop as a result of Covid-19 Pneumonia?
(Unknown why)

A

Diabetic Ketoacidosis

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10
Q

What is the disease process of having a low blood pH?
How does it do harm to the brain?

A

Enzyme Phosphofructokinase (glycolysis) is pH sensitive
If pH decreases (more acidic) it doesn’t work as well, this means glucose cant be utilised in the brain

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11
Q

What are the clinical consequences of having low blood pH (Acidosis)?

A

Coma
Death in Coma
Drowsiness
Stupor

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12
Q

What is the relationship between H+ conc and pH?

A

As [H+] inc, pH decreases

As [H+] dec, pH inc

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13
Q

What is the ratio of CO2:HCO3- needed to ensure that the pH is maintained in the health physiological range?

A

1:20

1CO2 : 20HCO3-

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14
Q

What are the equations showing why CO2 leads do a decrease in blood pH?

A

CO2 + H2O <—> H2CO3

H2CO3 <—> H+ + HCO3-

So for every CO2 molecule only 1 HCO3- molecule is produced (we need 20 to be made to maintain pH) this leads to the ratio of CO2:HCO3- being off making it more acidic

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15
Q

What are the 3 different methods of CO2 transport needed to ensure the excess H+ ions dont always cause acidosis?

A

Carbamino compounds (30%)

Transported as bicarbonate ions (HCO3-) (60%)

Dissolved in plasma (10%)

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16
Q

What is a carbamino compound?

A

When CO2 binds to haemoglobin to be transported (binds to the amine group)

17
Q

How does CO2 being bound to Hb (carbamino compound help prevent changes in pH?

A

Stops the CO2 being able to enter blood since its trapped in red blood cell

18
Q

How does the formation of carbamino compounds help with gas exchange?

A

Bohr effect

Haldane effect

19
Q

How does the formation of carbamino compounds help with gas exchange? (Bohr effect)

A

Lots of CO2 binds to Hb at highly metabolically active tissues
This stabilises the T state of haemoglobin promoting the release of O2 to the tissues

20
Q

How does the formation of carbamino compounds help with gas exchange? (Haldane effect)

A

When CO2 is given up by Hb at the lungs which puts Hb in more of the R state making it have a higher affinity for oxygen

21
Q

What enzyme in the red blood cell catalyses the dissociation of carbonic acid?

A

Carbonic anhydrase

22
Q

When carbonic acid dissociates in the red blood cell, how does the cell prevent the excess build up of HCO3- ions in the cell?

A

Chloride bicarbonate exchanger
HCO3- moved out Cl- ions moved in

23
Q

How does the oxygenation of haemoglobin affect the binding of H+ to Hb?

A

When Hb deoxygenated more H+ ions can bind

When Hb oxygenated less H+ ions can bind

24
Q

How do bicarbonate ions act to buffer acid?

A

The H+ reacts with HCO3-
Leads to H20 + CO2 -> H+ + HCO3- reaction equilibrium getting pushed to the left

25
What are the 2 organs responsible for regulating the acid base balance in the body?
Lungs Kidneys
26
How do the lungs help regulate the acid base balance?
Control rate and depth of breathing to change how much CO2 is in the body
27
How do the kidneys help regulate the acid base balance?
Change how much HCO3– (bicarbonate) in the blood HCO3- made by RBC, this gets released in plasma and then stored in the kidneys
28
What is the relative speed of the kidneys and lungs in terms of helping control the acid base balance?
Kidneys = slow control (HCO3- system takes a while) Lungs = fast control
29
How do the kidneys control acid base regulation?
Blood cells make HCO3- HCO3- conc controlled by kidneys by changing the amount they excrete in the urine
30
Which buffering system is the quickest to respond?
Respiratory is faster Metabolic/renal is slower
31
How does pH change as pCO2 changes in the alveoli/blood?
High pCO2 = pH low Low pCO2 = pH high
32
How do levels of bicarbonate change if levels of pCO2 increase or decrease?
Levels of bicarbonate do not change in response to changing levels of CO2
33
How does CO2 dissolving in plasma change depending on the partial pressure of CO2?
Higher partial pressure of CO2 means more CO2 dissolves in plasma
34
What is hypocapnia and hypercapnia?
Hypocapnia = low CO2 levels Hypercapnia = high CO2
35
What are the 3 steps to interpreting an Arterial Blood Gas?
Look at the pH is it acidosis or alkalosis Look at pCO2 result to see if the acidosis or alkalosis is due to a respiratory problem Look at the bicarbonate result to see if its metabolic reaction
36
Look at this patients Arterial Blood Gas and diagnose: pH: 7.33 PCO2: 4.1kPa (4.5-6) HCO3-: 16mmol/L (22-26)
PH is low therefore acidosis PCO2 is low so isn’t the cause of the acidosis but HCO3- is low so is the cause of the acidosis So this is metabolic acidosis which is partially compensated since the pCO2 is low (increased ventilation)
37
Look at this patients Arterial Blood Gas and diagnose: Pateint is having a panic attack and is hyperventilating pH: 7.5 PCO2: 4.5kPa (4.7-6) HCO3-: 25mmol/L (22-26) PO2 = 14kPa (9.3-13.3) Is it acute or chronic?
Respiratory alkalosis Its not compensated and its acute
38
Look at this patients Arterial Blood Gas and diagnose: Long standing COPD pH: 7.35 PCO2: 8kPa (4.5-6) HCO3-: 33mmol/L (22-26) PO2 = 8.2kPa (9.3-13.3)
Fully compensated respiratory acidosis Ph is normal so its fully compensated And the co2 is high so this shows it a respiratory cause
39
What would a patients arterial blood gas look like in a patient who’s got fully compensated metabolic acidosis?
PH = normal HCO3- = low PCO2 = low PO2 = high The gases are these levels since hyperventilation

Y2 - Resp (23 decks)

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