Part acid base Flashcards
Clinical presentation of metabolic acidosis
usually not associated with severe acidemia
-relatively asymptomatic
Severe acute metabolic acidosis (pH <7.2) is when you get symptoms of respiratory, hyperventilation
_______depression
Cardiovascular
_________:Alters K homeostasis
hyperventilation (the body eliminates more of the CO2 and brings the pH up)
CNS depression
Hyperkalemia
Hyperkalemia can cause arrythmias
Whose going to do the compensation for metabolic acidosis?
lungs by hyperventilation causing a decrease of CO2
Compensation of metabolic acidosis
Increase carbon dioxide excretion by increasing the _________rate.
This results in a decrease of PaCO2
decrease
Asymptomatic Patients with Mild to ModerateAcidema (HCO3 12-20mEq/L, pH 7.2-7.4)
(pt has no symptoms and pH is greater than 7.2)
What do we need?
You do not need emergent treatment
You can gradual correct the acidemia over days to weeks using the ________
You do not need emergent treatment
You can gradual correct the acidemia over days to weeks using the oral sodium bicarbonate tablet
If pt can’t swallow an oral sodium bicarbonate you can choose a powder
Acute severe metabolic acidosis(HCO3=8mEq/L
pH<7.2)
Treatment is what? give more of the bicarbonate by giving alkaline therapy
Although pt is in severe metabolic acidosis your job is NOT to bring the pH immediately to 7.35 maybe just above 7.2 across the severe metabolic acidosis then you can manage the pt gradually
The common therapy we use is IV sodium bicarbonate therapy
Acute severe metabolic acidosis
risks of bicarbonate therapy
extracellular fluid volume __________
_____________
Hypokalemia
Paradoxical transient intraceullar acidosis (when you give bicarbonate it will react with proton and forms carbonic acid and breaks down to CO2 and water..co2 is an acid initially will present with worsening acidosis but the gradually the body can fix it
overload
Hypernatremia
When you see metabolic acidosis immediately calculate anion gap if its gap is high then think about m.u.d.piles as the cause
if gap is normal
so nonanion gap metabolic acidosis most likely cause is losing bicarbonate either GI or renal how do you treat? depending on whether its severe so with symptoms or not
Regardless severe or not severe you use bicarbonate therapy
In nonsevere you use oral bicarbonate po tablet
in severe you give sodium bicarbonate infusion
Respiratory acidosis
Acidosis means pH means less than 7.35
Because primary disorder is primary we are dealing with CO2 which means an increase in CO2…and pt is hypoventilation your retaining more of the CO2
What patients experience respiratory acidosis?
asthma, COPD
Causes of respiratory acidosis?
Impaired gas exchange in the lungs for instance asthma, COPD, _________edema (fluid accumulation in the lungs so you have less space for air exchange)
pulmonary _________(clotting in the pulmonary system)
___________(infection and fluid accumulation in the lungs)
pulmonary edema
pulmonary embolism
Pneumonia
Our breathing is regulated by the breathing center in the brain
Causes of respiratory acidosis
Impaired central nervous system respiratory drive
Stroke
Tumor
Drugs (e.g. __________and sedatives/hypnotics)
Opioids
Sedatives/hypnotics are benzos and barbiturates is going to depress the CNS respiratory system center and if someone has stroke,tumor infecting the brain…breathing center control
Causes of respiratory acidosis
Impaired neuromuscular function affecting the ____________or chest wall
diaphragm
Clinical Presentation
Respiratory acidosis
“I cant _______
Retention of CO2 by lungs
Hyperkalemia
I can’t breathe
Whose going to compensate for respiratory acidosis?
The kidneys regulate bicarbonate so kidneys will excrete more________ and less bicarbonate so it will increase the pH
excrete hydrogen ions
