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CR2 > Respiratory Acidosis And Alkalosis > Flashcards

Respiratory Acidosis And Alkalosis Flashcards

1
Q

Normal pH range of arterial blood

A

7.35-7.45

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2
Q

Normal pH of venous blood

A

7.31-7.41

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3
Q

Why is arterial blood gas being used less often

A

Invasive
Painful

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4
Q

Acidaemia

A

State where arterial blood pH <7.35

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5
Q

Acidosis

A

Process leading to acidaemia

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6
Q

Alkalaemia

A

State where arterial blood pH >7.45

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7
Q

Alkalosis

A

Process leading to alkalaemia

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8
Q

Bicarbonate buffer system equation

A

CO2 + H2O <—> H2CO3 <—> H+ + HCO3

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9
Q

Does the human body normally have a higher concentration of HCO3- or CO2

A

HCO3-

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10
Q

What organ controls CO2 levels

A

Lungs

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11
Q

What is the weak acid and conjugate base in the bicarbonate buffer system

A

Weak acid - CO2
Conjugate base - HCO3-

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12
Q

Henderson hasselbach equation

A

pH = pKa + log ([conjugate base]/[weak acid])

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13
Q

Why is CO2 classed a s a weak acid

A

CO2 levels determine formation of carbonic acid

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14
Q

What ratio is blood pH dependent on

A

[HCO3-] : pCO2

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15
Q

Do the lungs or kidneys compensate more quickly for abnormal blood pH

A

Lungs

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16
Q

Which organ controls HCO3- concentration

A

Kidneys

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17
Q

4 forms of acid base disturbance

A

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

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18
Q

What causes respiratory acidosis

A

Inadequate pulmonary excretion of CO2

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19
Q

What causes respiratory alkalosis

A

Excess pulmonary excretion of CO2

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20
Q

What causes metabolic acidosis

A

Excess loss of HCO3 via kidney/GI tract or excess H+ production that consumes HCO3

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21
Q

What causes metabolic alkalosis

A

Excess loss of protons via kidney or GI tract

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22
Q

Which form of acid base disturbance has 2 possible mechanisms

A

Metabolic acidosis

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23
Q

What can cause inadequate CO2 excretion

A

Hypoventilation
Ventilation perfusion mismatch

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24
Q

What conditions can cause respiratory acidosis

A

Brain injury to CNS resp centres
Diseases of gas exchange
Diseases of chest
Diseases of nerves + muscles driving ventilation
Severe obesity
Drugs that suppress breathing

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25
Q

How can scoliosis lead to respiratory acidosis

A

Impaired ventilation

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26
Q

How does pCO2 increase with no compensation affect plasma pH

A

Decrease - more acidic

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27
Q

Over what time frame is HCO3- raised/lowered to compensate for respiratory acidosis or alkalosis

A

Few hrs to starts
3-5 days for full effect

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28
Q

Which way is the bicarbonate buffer system pushed if pCO2 increases w no compensation

A

To Right

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29
Q

Is CO2 a lipid soluble or water soluble gas

A

Lipid soluble

30
Q

Does CSF or plasma change pH more quickly

A

CSF

31
Q

Why does CSF change pH more quickly than plasma in response to elevated pCO2

A

CSF has little protein so less buffered than plasma

32
Q

Can CO2 cross the blood brain barrier

A

Yes

33
Q

Respiratory acidosis symptoms

A

Headache
Lethargy
Anxiety
Sleepiness
Fatigue
Memory loss
Restlessness
Muscle weakness

34
Q

Respiratory acidosis signs

A

Drowsiness
Gait disturbance
Decr deep tendon reflexes
Disorientation
Tremor
Myoclonic jerks
Papilloedema
Tachycardia
Cardiac arrhythmia
Decr BP
skin flushing

35
Q

Why does skin flush during respiratory acidosis

A

CO2 causes vasodilation

36
Q

How does respiratory acidosis decr brain blood flow

A

Incr CO2 causes cerebral artery vasodilation -> incr intracranial pressure -> decr blood flow

37
Q

Does acute or chronic respiratory acidosis have more severe symptoms

A

Acute

38
Q

How does the brain compensate for respiratory acidosis

A

Reabsorbs more HCO3

39
Q

Why are signs and symptoms less severe in chronic respiratory acidosis than acute

A

Brain and kidneys have time to compensate

40
Q

How is respiratory acidosis diagnoses

A

Arterial blood gas
Signs and symptoms

41
Q

Acute respiratory acidosis ABG findings

A

Low blood pH
High blood pCO2
Normal plasma HCO3- levels

42
Q

Chronic respiratory acidosis ABG findings

A

Low normal blood pH
High blood pCO2
High blood HCO3-

43
Q

How is respiratory acidosis treated

A

Treat underlying cause - bronchodilator drugs, noninvasive positive pressure ventilation, opioid OD reversal, oxygen

44
Q

Which respiratory acidosis patients can be harmed by giving oxygen

A

Patients with chronic hypercapnia from chronic CO2 retention and chronic respiratory acidosis

45
Q

Why should patients with chronic hypercapnia be given oxygen very carefully

A

Can worsen CO2 retention from ventilation perfusion mismatch

46
Q

Where is carbonic anhydrase present

A

All cells - not plasma

47
Q

What does carbonic anhydrase catalyse

A

Bidirectional conversion of CO2 + H2O <—> HCO3- + H+

48
Q

How can kidneys compensate for respiratory acidosis

A

Incr HCO3- reabsorption in kidney proximal tubule
Incr H+ excretion
Incr ammonium excretion
Incr phosphate excretion

49
Q

Where does phosphate excreted as part of metabolic compensation for respiratory acidosis come from

A

Breakdown of Calcium phosphate in bones

50
Q

What is the mechanism of primary respiratory alkalosis

A

Lungs exhale higher than normal amount of CO2 causing hypocapnia

51
Q

What type of acid base imbalance is caused by hyperventilation

A

Respiratory alkalosis

52
Q

Acute respiratory alkalosis symptoms

A

Hyperventilation
Dizziness
Light headedness
Confusion
Agitation
Blurred vision
Cramps
Tingling/numbing around mouth - Hands

53
Q

Acute respiratory alkalosis signs

A

Muscle twitching
Hyperactive reflexes
Spasms
Weakness
Seizures
Syncope
Irregular heartbeat
Tetany

54
Q

How can respiratory alkalosis cause tetany

A

Decr in free calcium

55
Q

What position is the typical alkalaemia hand spasm

A

Flexed wrist
Extended DIPs and PIPs

56
Q

Does calcium protein binding increase or decrease with pH increase

A

Increase

57
Q

Why does pH affect free calcium levels

A

Calcium ions compete with H+ to bind to albumin, more H+ -> less Ca binding -> more free Ca

58
Q

Metabolic effects of respiratory alkalosis

A

Constriction of cerebral blood vessels
Impaired O2 delivery to tissues
Incr neuromuscular activity -> arrhythmias and tetany

59
Q

Tetany

A

Involuntary and sustained muscle contraction

60
Q

Why does chronic respiratory alkalosis lead to hypokalaemia

A

Incr potassium excretion to replace H+ excretion

61
Q

Causes of respiratory alkalosis

A

CNS lesions
Salicylate overdose
Pulmonary embolism
Pregnancy
Anxiety/stress
Pain
Liver cirrhosis
Sepsis
Hypoxaemia
Fever

62
Q

How is respiratory alkalosis diagnosed

A

Symptoms
ABG

63
Q

How is respiratory alkalosis treated

A

Treat underlying cause

64
Q

Why does breathing into paper bag help hyperventilation syndrome

A

Rebreathed air has high CO2 restoring CO2 levels

65
Q

How does the kidney compensate for chronic respiratory alkalosis

A

Incr bicarbonate excretion by decr carbonic anhydrase levels

66
Q

Which type of respiratory failure has hypercapnia as well as hypoxaemia

A

Type 2

67
Q

Which form of respiratory failure is more common

A

Type 1

68
Q

How can alveolar impairment cause hypoxaemia without causing hypercapnia

A

CO2 diffuses out more easily than O2 diffuses in

69
Q

What conditions can cause type 1 respiratory failure

A

Pulmonary oedema
Pneumonia
Pulmonary embolism

70
Q

What conditions can cause type 2 respiratory failure

A

Severe COPD
chest wall deformity
Respiratory muscle weakness
Central nervous system depression/injury
Asthma attacks

CR2 (33 decks)

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