Step U - Underlying Cause Flashcards
What are the four causes of acid/base abnormality?
- respiratory acidemia
- respiratory alkalemia
- metabolic acidemia
- metabolic alkalemia
In respiratory acidemia, cerebral blood flow may ____ with an increase in carbon dioxide
more than double
What are the signs of high CO2?
- increased CMO
- tachycardia
- skin flushed
- diaphoretic
- bounding pulse
Blood flow is ____ with chronic hypercapnia
normal
What are two signs of severe hypercapnia?
- hypotension
- arrhythmias
What is the acronym for respiratory acidemia (increase in volatile acids)?
C O N V E N I E N T
What does the C in respiratory acidemia stand for?
COPD code
What does the O in respiratory acidemia stand for?
oxygen excess in COPD
What does the 1st N in respiratory acidemia stand for?
neuromuscular disorders (MG, GB, ALS, polio)
What does the V in respiratory acidemia stand for?
V/Q mismatch (lung cancer)
What does the 1st E in respiratory acidemia stand for?
exhaustion (status asthmaticus)
What does the 2nd N in respiratory acidemia stand for?
neurological disorders (central sleep apnea, intracranial hypertension)
What does the I in respiratory acidemia stand for?
inadequate CMV (hyperkalemia)
What does the 2nd E in respiratory acidemia stand for?
excessive CO2 production (permissive hypercapnia, burns, sepsis)
What does the 3rd N in respiratory acidemia stand for?
narcotics and other CNS depressants
What does the T in respiratory acidemia stand for?
trauma to the respiratory center
What should you do on patients who have a neuromuscular disorder?
- NIF
- VC
What are the signs and symptoms of respiratory alkalemia?
- tingling
- numbness of hands and feet
- tachycardia
- increased CMO
In respiratory alkalemia, cerebral blood flow is ____
decreased
What is the acronym of respiratory alkalemia?
H O R N S
What does the H in respiratory alkalemia stand for?
hypoxemia
What does the O in respiratory alkalemia stand for?
overzealous mechanical ventilation
What does the R in respiratory alkalemia stand for?
restrictive lung disorder (stimulates faster breathing)
What are some examples of restrictive lung disorders that cause respiratory alkalemia?
- fibrosis
- CHF
- ARDS
- pneumonia
What does the N in respiratory alkalemia stand for?
neurologic disorders
What are some examples of neurologic disorders that cause respiratory alkalemia?
- infection
- trauma
- salicylates
- drugs
What does the S in respiratory alkalemia stand for?
septicimia
What drug is used to stimulate the diaphragm in patients with COPD?
aminophylline
What is the acronym for metabolic acidemia caused by an increased in fixed acids?
T A L K
What does the T in metabolic acidemia stand for?
Toxins
What are some examples of toxins that cause metabolic acidemia?
- salicylates
- wood alcohol
- antifreeze
- toluene
What does the A in metabolic acidemia stand for?
azotemic renal failure
What are the 3 phases of renal failure?
pre
intra
post
What are indicators that a patient is in pre renal failure?
- BUN >80
- creatinine unaffected
- SP > 1.02
- dark urine
- hypotension or hypovolemia
What are indicators that a patient is in intra renal failure?
- BUN >80
- creatinine >8
- SP <1.015
- clear urine
What are indicators that a patient is in post renal failure?
- low urine output (if any, usually bloody)
- BUN and creatinine cannot be measured
What drug is given to a patient in metabolic acidemia?
lasix
What drug is given to a patient in metabolic alkalemia?
diamox
What is the only exception in decrease in bases due to buffering?
chloride
What does the L in metabolic acidemia stand for?
lactic acid (most common and caused by hypovolemia)
What are some examples that cause an increase in lactic acid?
- hypoxemia
- ethanol intake
- liver damage
- poisonings
What are the causes of an increase in protein metabolism?
- bleeding into stomach
- corticosteroids
- increase in protein intake
- infection
- starvation
- surgery
- trauma
What are the causes of a decrease in excretion of protein?
- dehydration
- vomiting
- diarrhea
What should you look at to assess kidney function and what is the normal range?
creatinine; 0.5-1.5
What does the K in metabolic acidemia stand for?
keto acidosis (diabetic crisis)
What are the causes of keto acidosis?
- hyperglycemia
- glycosuria
- ketouria
What is glycosuria?
excess glucose in urine
What are the signs/symptoms of keto acidosis?
- vomiting
- hyperkalemia
- kussmauls breathing
- boryborgymus
What is boryborgymus?
swelling of the stomach
What is ketouria?
accumulation of ketone bodies
What are the causes of metabolic acidemia due to a decrease in bases?
- renal tubular acidosis
- enteric fluid loss
- diamox
What are the ways or diseases that cause a to have enteric fluid loss?
- biliary or pancreatic disease
- enteric drainage tubes
- diarrhea
- sustained deep vomiting
What is the acronym for metabolic alkalemia?
H I G H B A S E
What does the 1st H in metabolic alkalemia stand for?
hypokalemia, hypochloremia, hypovolemia
What does the I in metabolic alkalemia stand for?
ingestion of base (milk, excessive bicarb, chewing tobacco)
What does the G in metabolic alkalemia stand for?
gastric fluid loss (NG tube)
What does the 2nd H in metabolic alkalemia stand for?
hyperaldosterone (increase in aldosterone increases your level of sodium bicarb)
What does the B in metabolic alkalemia stand for?
blood transfusion
Why does a blood transfusion cause metabolic alkalemia?
in stored blood, there is an anticoagulate called citrate. when a person metabolizes citrate, it is converted to bicarb and s/he ends up with metabolic alkalemia
What does the A in metabolic alkalemia stand for?
adrenocortical hypersecretion (increase in sodium bicarb absorption)
What does the S in metabolic alkalemia stand for?
steroids (increase in sodium bicarb absorption)
What does the E in metabolic alkalemia stand for?
eucapnic ventilation post hypercapnia (buffering left over from metabolic acidemia)
How many steps are there for highbase?
4
What is the 1st step for highbase?
look for high base intake
What is the 2nd step for highbase?
look for any diuretic therapy
What is the 3rd step for highbase?
check hydration status (dehydration = increase in aldosterone)
What is the 4th step for highbase?
check for adrenal disease
