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Clinical Pathology > UNIT 2 - Lecture 6: Acid Base 2 > Flashcards

UNIT 2 - Lecture 6: Acid Base 2 Flashcards

1
Q

Which diagnostic theory is clinically useful and involves alterations in pH due to just changes in HCO3- and H+?

A

classical model

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2
Q

What acid base parameters do we measure with serum chemistry?

A
  1. Bicarb or total CO2
  2. Anion Gap
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3
Q

What acid base parameters can we measure with a blood gas?

A
  1. pH
  2. pCO2
  3. paO2
  4. Base excess
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4
Q

What does bicarb on a chemistry mean?

A

[] of bicarb in serum

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5
Q

What does total CO2 on a chemistry mean?

A

Cumulative [] of bicarb, carbonic acid, and CO2

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6
Q

TCO2 is functionally the same thing as _____.

A

bicarb

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7
Q

Bicarb and TCO2 can be modulated by the _____ and _____.

A

liver, kidneys

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8
Q

What type of sample is a chemistry and how is it measured?

A

Serum sample, directly measured

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9
Q

What type of sample is a blood gas and how is it measured?

A

Heparinized whole blood;

Calculated from other parameters

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10
Q

Which diagnostic test is stable? How long is it good for?

A

Serum biochemistry - good @ 4ºC for 5 days

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11
Q

Which diagnostic test is unstable? How long is it good for?

A

Blood gas - good @ 25ºC for 30 min

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12
Q

What is the anion gap and what ions can we measure?

A

Difference between unmeasured anions and cations in blood;

Cations measured = Na+, K+

Anions measured = HCO3-, Cl-

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13
Q

T/F: Total positives in blood will always be less than total negatives in blood

A

False; they will always equal each other

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14
Q

There will always be more unmeasured _____ than _____ in the blood; this is referred to as the anion gap.

A

anions, cations

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15
Q

How is the anion gap calculated (what ions are used and how)?

A

Na+ + K+ - Cl- - HCO3-

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16
Q

What does an elevated anion gap indicate?

A

Buildup of organic acids

(EX: lactic acid, ketoacids, uremic acids, ethylene glycol, acetaminophen, abx)

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17
Q

What are the guidelines for getting a sample for blood gas analysis?

A

Use lithium heparin syringe to get whole blood, no air bubbles trapped in sample, run within 30 min at 25 deg C

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18
Q

What kind of blood is easier to draw for a blood gas?

A

venous

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19
Q

What values can you get on a blood gas from venous and arterial blood? What value can only be measured from arterial blood?

A

Both = pH, pCO2, HCO3-

Arterial only = paO2

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20
Q

If air bubbles occur or blood is exposed to atmosphere, what errors can occur in a blood gas?

A

Increased pH or paO2

Decreased pCO2 or HCO3-

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21
Q

If it takes too long to analyze a blood gas, what can happen?

A

Decreased paO2 or pH

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22
Q

What is pCO2?

A

Partial pressure of dissolved CO2 in blood

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23
Q

What does hypoventilation cause?

A

Decreased pulm release of CO2 –> increased blood pCO2 –> acidification

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24
Q

What is another term for hypoventilation in terms of CO2?

A

hypercapnia

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25
Q

What does hyperventilation cause?

A

Increased pulm release of CO2 –> decreased blood pCO2 –> alkalinization

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26
Q

What is another term for hyperventilation in terms of CO2?

A

hypocapnia

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27
Q

T/F: pCO2 = TCO2

A

False!!

28
Q

Conceptually, we should think of pCO2 as a(n) _____.

A

acid

29
Q

What is paO2?

A

Partial P of dissolved oxygen in arterial blood

30
Q

T/F: paO2 does NOT reflect total oxygen content in blood

A

True

31
Q

What value is not included in paO2?

A

Hgb bound to oxygen

32
Q

What information does paO2 provide?

A

Info on how well pulmonary system is oxygenating blood

33
Q

What happens to paO2 during hypoxemia?

A

It decreases

34
Q

What is hypoxemia usually due to?

A

Disorders of respiratory ventilation

35
Q

Acidosis is too much _____ or too little _____.

A

CO2, HCO3

36
Q

Alkalosis is too much _____ and too little _____.

A

HCO3, CO2

37
Q

What are the 4 steps to the diagnostic approach of acid base balance?

A
  1. Assess pH
  2. Assess HCO3 and pCO2
  3. Assess anion gap
  4. Summarize and interpret
38
Q

In the diagnostic approach, what does assessing pH determine?

A

Severity of acid base disturbance

39
Q

In the diagnostic approach, what does assessing HCO3 and pCO2 determine?

A
  1. Determines df/dx of acid base disturbance
  2. Determines compensation
40
Q

In the diagnostic approach, what does assessing the anion gap determine?

A

Subtype of metabolic acidosis

41
Q

What is normal blood pH?

A

~7.4

42
Q

What is the pH range for acidemia?

A

~6.8-7.3

43
Q

What is the pH range for alkalosis?

A

~7.5-7.8

44
Q

Why does a normal pH not necessarily rule out an acid base disturbance?

A

It might imply buffers and adaptation are maintaining pH in the normal range

45
Q

Low HCO3 = _____ _____

A

metabolic acidosis

46
Q

High HCO3 = _____ _____

A

metabolic alkalosis

47
Q

What are the two types of metabolic acidosis and what causes each?

A
  1. Secretional acidosis = loss of HCO3 from body
  2. Titrational acidosis = loss of HCO3 via neutralization of organic acid
48
Q

What is metabolic alkalosis?

A

Overproduction or retention of HCO3

49
Q

In what animals does metabolic alkalosis most commonly happen?

A

Cattle with bloat;

Can also happen with accidental supplementation with bicarb

50
Q

Low pCO2 = _____ _____

A

respiratory alkalosis

51
Q

High pCO2 = _____ _____

A

respiratory acidosis

52
Q

Which pCO2 condition is seen more commonly?

A

respiratory acidosis

53
Q

What is respiratory acidosis and what does it lead to?

A

Retention of pCO2 –> hypoventilatory disease

54
Q

What is respiratory alkalosis and what does it lead to?

A

Excess removal of pCO2 –> hyperventilation

55
Q

How does the body respond to metabolic acidosis?

A

Compensatory respiratory alkalosis

56
Q

How does the body respond to metabolic alkalosis?

A

Compensatory respiratory acidosis

57
Q

How does the body respond to respiratory acidosis?

A

Compensatory metabolis alklaosis

58
Q

How does the body respond to respiratory alkalosis?

A

Compensatory metabolic acidosis

59
Q

When there is a primary metabolic acid base disturbance, how long does it take for the body to respond?

A

within minutes

60
Q

When there is a primary respiratory acid base disturbance, how long will it take the body to respond?

A

days

61
Q

If your patient is acidemic with a low pCO2 and a low HCO3, what is happening?

A

Primary metabolic acidosis with compensatory respiratory alkalosis

62
Q

What does increased AG indicate?

A

Presence of organic acid

63
Q

If you have a metabolic acidosis and the AG is increased, what does this mean?

A

Titrational metabolic acidosis

HCO3 is low because it is titrating an organic acid

64
Q

If you have a metabolic acidosis and the AG is normal, what does this mean?

A

Secretional metabolic acidosis

HCO3 low because it is secreted from the body

65
Q

If your patient is acidemic, has low HCO3, normal pCO2, and an elevated AG, what does this mean?

A

Acidemia caused by primary titrational metabolic acidosis with NO respiratory compensation

Clinical Pathology (22 decks)

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