Lecture 6 Acid Base Emergencies Dr. Benzoni Flashcards
Which type of pH imbalances does the body handle better?
The body is able to handle acidic imbalances much better than basic.
Blood pH is described using which suffix?
Blood pH state is described using which suffix?
Blood pH is via “emia”
Blood state is via “osis”
Ex: Patient is acidemic secondary to respiratory acidosis with incomplete metabolic compensation and associated hypoxia with an elevated anion gap.
12/8/.01
This is an acute pH change.
pH changes 0.1 for each change:
PaCO2 = 12 (Acid)
HCO3- = 8 (Alkaline) measured via electrolytes.
How is HCO3- measured?***
On electrolyte panels, must calculated.
How is SaO2 measured?
It is a log function of O2.
How does a venous vs arterial blood gas test differ?
Arterial blood gases are threatening to the limb and very painful.
Venous blood gases only differ by 0.05 pH. CO is measured venously.
When is compensation considered complete?
Only if the pH is normal.
Can only really happen in respiratory acidosis. You would need to stop breathing to compensate for metabolic alkalosis.
What does an elevated ion gap generally indicate?
Generally indicates an unmeasured - ion typically through metabolic products, toxins, etc.
What causes a low anion gap metabolic acidosis?
Very rare due to elevated proteins.
Seen in multiple myeloma etc.
What causes a normal anion gap?
Increased Cl- and increased excretion of bicarbonate.
Typically through drugs such as spironolactone and acetazolamide.
Bicarbonate can also be lost through diarrhea, fistulas etc.
What can cause an elevated anion gap metabolic acidosis?
MUD PILES Methanol Uremia DKA Paracetamol/Propylene glycol Infection Lactic acidosis Ethylene glycol Salicylates.
What does ethylene glycol cause?
Unrelenting metabolic acidosis.
Elevated anion gap
fluorescent urine**
treat it with ethanol, fomepizole, dialysis.
What does Salicylate intake cause?
“Bimodal effects”
Acidemia
Alkalemia and respiratory problems through CNS issues.
what is the benefit of using end tidal capnography?
Useful for detecting DKA and COPD earlier.
What are alternative methods to arterial blood gas measurements?
One could utilize venous blood gas measurements in conjunction with pulse oxometry.
They are less difficult to obtain and less painful.
