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CR2 > Respiratory acidosis and alkalosis > Flashcards

Respiratory acidosis and alkalosis Flashcards

1
Q

What can cause respiratory acidosis?

A
  • hypoventilation
  • diseases of airways (asthma, COPD)
  • diseases of chest (scoliosis)
  • diseases affecting nerves and muscles (reduced drive for inflation/deflation)
  • severe obesity
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2
Q

State whether the following are increased or decreased in respiratory acidosis:

  • PaCO2
  • [HCO3-]
  • ratio of [HCO3-]/pCO2
  • pH
A
  • PaCO2: increased (>40 mmHg)
  • ratio of HCO3-/pCO2: reduced
  • pH: reduced
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3
Q

What are the S+S of respiratory acidosis?

A
  • headache
  • disorientation
  • drowsiness
  • tremor
  • lethargy
  • blunted deep tendon reflexes
  • anxiety
  • myoclonic jerks
  • papilloedema (optic disc) + swelling of blood vessels in eyes
  • fatigue
  • reduced BP
  • memory loss
  • tachycardia
  • restlessness
  • muscle weakness
  • slowed breathing
  • gait disturbance
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4
Q

How is respiratory acidosis diagnosed?

A
  • symptoms
  • ABG (increased pCO2)
  • pH (reduced/<7.35)
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5
Q

How should respiratory acidosis be treated/managed?

A
  • bronchodilators
  • non invasive pressure ventilation/ mechanical ventilation
  • O2 if blood O2 is low
  • stop smoking
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6
Q

Compare acute and chronic respiratory acidosis.

A

Acute:

  • PaCO2 >6.3kPa/47mmHg
  • Acidaemia (<7.35)
  • Occurs due to abrupt failure of ventilation
  • may be caused by depression of central respiratory centre (cerebral disease or drugs)
  • can’t adequately ventilate (NM disease)
  • airway obstruction (asthma/COPD)

Chronic:

  • PaCO2 >6.3 kPa/47 mmHg
  • Blood pH normal/near normal (renal compensation = increased serum bicarbonate, >30 mmHg)
  • secondary to many disorders, such as COPD ( hypoventilation in COPD = reduced response to hypoxia and hypercapnia)
  • increased V/Q due to increased dead space and reduced diaphragm function (fatigue, hyperinflation)
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7
Q

Explain how the kidneys can compensate for respiratory acidosis.

A
  • kidneys produce HCO3- –> high blood [H+]
  • increased HCO3- = high PaCO2
  • increased HCO3- retention = compensatory metabolic alkalosis
  • -> max level of plasma HCO3- = 45 mmol/L
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8
Q

Explain how hyperventilation can cause respiratory alkalosis.

A
  • increased breathing rate = increased alveolar respiration - more CO2 is expelled from blood
  • H+ + HCO3- – CA –> CO2 + H2O reaction shifts to the RIGHT
  • net result = reduced circulating [H+] = increased pH
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9
Q

What are the S+S of respiratory alkalosis?

A
  • light headedness
  • agitation
  • confusion
  • cramps + tingling
  • numbing around mouth and in fingers/hands
  • muscle twitching
  • increases rate of breathing (hyperpnoea)
  • chest pain
  • blurred vision
  • spasms (tetany - intermittent muscular spasms)
  • seizures
  • irregular heart beat
  • dizziness
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10
Q

What is the difference between symptoms associated with resp acidosis and resp alkalosis?

A

Acidosis = symptoms are associated with fatigue (drowsiness, lethargy, anxiety)

Alkalosis = symptoms are associated with activity (seizures, tremor, gait disturbance, altered deep tendon reflex)

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11
Q

What can cause respiratory alkalosis?

A
  • intracerebral haemorrhage, meningitis, stroke (alter resp. drive)
  • salicylate + progesteron drug usage
  • anxiety, hysteria, stress and pain
  • cirrhosis of liver
  • sepsis/pneumonia/infection
  • increased body temperature
  • hypoxia
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12
Q

Compare acute and chronic respiratory alkalosis.

A

Acute:

  • occurs rapidly
  • may lose consciousness (rate of ventilation will become normal again)

Chronic:

  • usually symptomless due to metabolic compensation (kidney excretes HCO3-)
  • –> min [HCO3-] = ~12 mmol/L
  • full compensation can occur in at least 7 days
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13
Q

How is respiratory alkalosis diagnosed?

A
  • ABG (reduced CO2, increased HCO3-)

- pH (raised)

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14
Q

Give examples of situations in which type 1 respiratory failure occurs?

A
  • pulmonary oedema
  • pneumonia
  • pulmonary haemorrhage

Fluid filling or collapse or alveolar units

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15
Q

How does type 1 respiratory failure occur?

A
  • reduced ventilation and reduced O2 uptake = hypoxia
  • CO2 diffuses out more easily than O2 diffuses in = normocapnia
  • V/Q mismatch: if a lobe is poorly ventilated, capillaries constrict, blood flow is directed towards ventilated areas
  • shunting of blood across lungs
  • poor gas exchange
  • reduced minute ventilation and increased dead space ventilation (less gas in alveoli)
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16
Q

How can anion gap be calculated and what are the normal values? What causes a high anion gap?

A

([Na+] + [K+]) - ([Cl-] + [HCO3-]) = 12-16 mEq/L
[Na+] - ([Cl-] + [HCO3-]) = 8-12 mEq/L

High anion gap = loss of plasma HCO3- (indicates metabolic acidosis)

CR2 (36 decks)

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