Tic Tac Toe Method- determining acid base imbalance Flashcards
Step #1 Determine nml range:
pH 7.35-7.45 (> 7.45 means alkaline)
PCO2 35-45* ACIDIC (>45 means acidic)
HCO3 22-26
Step #2 Make grid;
Acid/NML/Base
PH
PCO2
HCO3
Step #3 Put X in grid for pt results for each value:
Ex: Patient Results:
ph 7.47: base; PCO2 31: base; HCO3 24: nml
Acid/NML/Base
PH X
PCO2 X
HCO3 X
Pt has Respiratory Alkalosis!Acid/NML/Base PH PCO2 HCO3 * Pt values: pH 7.46; PO2 86; HCO3 24
Acid/NML/Base PH PCO2 HCO3 Pt has:
Acid/NML/Base PH PCO2 HCO3 Patient values: pH 7.57; PO2 88; PCO2 36; HCO3 30
Acid/NML/Base PH PCO2 HCO3 Patient has:
Acid/NML/Base PH PCO2 HCO3 Patient values: pH 7.3; PO2 72; PCO2 50; HCO3 26
Patient has:
Acid/NML/Base PH PCO2 HCO3 Patient values: pH 7.14; PO2 70; PCO2 35; HCO3 19
Patient has:
Sources of Acid/Base in the Body:
Acids:
H+ ions Ketoacids carbon dioxide lactic acid Results: low K (hypokalemia)
Sources of Acid/Base in the Body:
Base:
Bicarbonate
Results: increased pH
Sources of Acid/Base in the Body:
Compensatory mechanism:
*chemical buffers on the scene- in seconds
*respiratory- retention OR elimination of CO2- in minutes
*renal- regulates bicarbs (HCO3) to combat hydrogen losses & gains- in hours, but > permanent when other 2 mechanisms fail.
(Renal system slowly gets to work & requires up to 5 days to complete healing.)
General ACIDOSIS sxs: “low, slow, & weak”
Neuro: confusion- 1st sxs
decreased DTRs
muscle weakness
CV: weak pulses
bradycardia
hypotensionGeneral ACIDOSIS sxs: “low, slow, & weak”
Causes:
Hypoventilation Drug overdose Pulmonary Edema Mechanical ventilation Mechanical NM Dz
Respiratory Acidosis
ph LOW
CO2 HIGH
Metabolic Acidosis
ph LOW
HCO3 LOW
Metabolic Acidosis
Causes:
DKA ASA (salicylic acid) overdose Renal failure severe diarrhea shock
Respiratory Acidosis
TXMT:
Meds:
(ex: naloxone, bronchodilators, mucolytics- thin secretions)
O2 (w/ caution! Use lowest art possible)
Mechanical ventilation
Tx the Cause
Metabolic Acidosis
Txmt:
Tx the cause (i.e., stop diarrhea, provide O2/insulin drip)
Give sodium bicarbs if pH < 7.2
Hyperventilation
Results in:
Respiratory Alkalosis
Respiratory Alkalosis
pH high
CO2 low
Respiratory Alkalosis
Causes:
initial stages of Pulmonary Emboli hypoxia fever pregnancy high altitudes anxiety
Metabolic Alkalosis:
pH high
HCO3 high
Metabolic Alkalosis:
Causes:
Overuse of antacids
K+ wasting diuretics
(Increased loss of H+)
Loss of gastric juices
General Alkalosis SXS “Excitable & Weak”
Dizziness Confusion Hyperreflexia Numbness/tingling (mouth/toes) Cramps/Twitching Tachycardia
Alkalosis
TXMT:
Tx the cause
Fall precautions
Rebreather mask (respiratory alkalosis)
ABG Interpretation Rules to Remember:
CO2= Respiratory & ACID HCO3= Metabolic (kidney) & base/alkaline
ABG Interpretation Rules to Remember:
Steps:
-Acid or Base? look at the pH
Respiratory or Metabolic? use ROME method
ROME:
Respiratory pH high; PCO2 low
Opposite pH low; PCO2 high
Metabolic pH high; HCO3-high (alkalosis)
Equal pH low; HCO3-low (acidosis)
Na+ Imbalance Electrolyte
Fx/indication of imbalance
- Na+ serves as primary determinant of blood osmolarity.
* It’s an important regulating acid/base balance & contributes to Fx of nervous system & other excitable tissue.
Na+ Imbalance Electrolyte
SXS of Hyponatremia:
Muscle cramps weakness HA depression apprehension feeling impending doom personality changes lethargy stupor coma anorexia N/V abd cramps diarrhea
Na+ Imbalance Electrolyte
SXS of HYPERnatremia:
- Polydipsia
- oliguria/anuria/high urine specific gravity
- dry skin/mucous membranes; decreased tissue turgor
- tongue- rough/fissured
- decreased salivation/tears
- agitation/restlessness
- HA/SZ/coma/decreased reflexes
- tachycardia; weak, thready pulse; low BP/vascular collapse
Cl- (chloride)
Fx/indications of imbalance
(extracellular)
Most often assoc w/ Na+
Plays role in reg of acid/base balance
Cl- (chloride)
LOW LEVELS: hypochloremia
SXS:
increased muscle tone twitching weakness tetany shallow breathing respiratory arrest mental confusion
Cl- (chloride)
HIGH LEVELS:
HYPERchloremia
SXS:
metabolic acidosis deep, rapid breathing weakness HA diminished cognitive ability cardiac arrest
Imbalance of K+
K+ is intracellular cation
Fx/indication of imbalance:
Distribution of K+ b/w intracellular & extracellular compartments regulates electrical membrane potentials, controlling excitability of nerve & muscle cells & contractility of skeletal, cardiac, & smooth muscle tissue.
Hypokalemia
sxs:
dizziness muscle weakness/leg cramps cardiac arrhythmias/hypotension nausea/anorexia/thirst poorly concentrated urine/polyuria
HYPERkalemia
sxs:
N/V/D/abd/intestinal cramps cardiac arrhythmias paresthesias/weakness muscle cramps EKG changes; R/F: cardiac arrest (w/ very elevated K+)
Mg++
(intracellular)
Fx/indication of imbalance:
Acts as a cofactor in many IC enzyme reactions; is essential to all reactions requiring ATP, for every step r/t replication & transcription of DNA; & for translation of mRNA & required for cellular energy metabolism.
