PHRM 864 > Acid-Base > Flashcards

Acid-Base Flashcards

(39 cards)

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1
Q

What is normal physiological pH?

A

7.35-7.45

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2
Q

Which value is impacted in metabolic disorders?

A

HCO3-

Lungs compensate for metabolic disorders.

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3
Q

Which value is impacted in respiratory disorders?

A

CO2

Kidneys compensate for respiratory disorders.

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4
Q

What is a normal PaCO2?

A

40

35-45 mmHg

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5
Q

What is a normal HCO3-?

A

24

22-26 mEq/L

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6
Q

What are adverse consequences from acidemia?

A
  • coma or altered mental status
  • Hyperventilation
  • Hyperkalemia
  • Impairment of cardiac contractility
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7
Q

What are adverse consequences of alkalemia?

A
  • decreased respirations
  • arteriolar constriction
  • decreased cerebral blood flow
  • stimulation of anaerobic glycolysis
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8
Q

What are the three standard mechanisms of acid regulation?

A
  • buffering
  • renal regulation
  • ventilatory regulation
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9
Q

What are the three components of the body’s buffering system?

A
  • bicarbonate
  • phosphate
  • protein
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10
Q

What is the onset and capacity of each of the buffers?

A
  • bicarbonate: rapid onset; intermediate capacity
  • phosphate: intermediate onset and capacity
  • proteins: rapid onset; limited capacity
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11
Q

Why is the bicarbonate/carbonic acid buffering system the first-line of defense of changes in pH?

A
  • there is more bicarbonate present in ECF than any other buffer component
  • the supply of CO2 is unlimited
  • the acidity of the ECF can be regulated by controlling either bicarbonate concentration or pCO2
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12
Q

How does the bicarbonate/carbonic acid buffering system maintain acid-base balance?

A
  • ventilatory eliminates pCO2 (acid) as needed
  • renally eliminates HCO3- (base) as needed
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13
Q

How does bicarbonate reabsorption and H+ excretion (renal regulation) maintain acid-base balance?

A
  • a majority of HCO3- is reabsorbed in the proximal tubule
  • H+ excretion takes place primarily in the distal tubule
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14
Q

What role does ventilatory regulation play in maintaining acid-base balance?

A
  • rapid onset and large capacity
  • breathing faster –> removes CO2 faster –> quickly makes blood less acidic
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15
Q

What is the primary change and compensation for metabolic acidosis?

A
  • change: decreased HCO3-
  • comp: decreased PaCO2
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16
Q

What is the primary change and compensation for metabolic alkalosis?

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A
  • change: increased HCO3-
  • comp: increased PaCO2
17
Q

How should metabolic acidosis be interpreted?

Study These Flashcards
A

PaCO2 should decrease by 1.25 times the fall in plasma HCO3-

18
Q

How is anion gap calculated?

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A

anion gap = Na - (Cl + HCO3)

  • used for metabolic acidosis

19
Q

What is a normal anion gap?

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A

3-11 mEq/L

  • if low –> non-gap
  • if high –> gap

20
Q

What are causes of non-anion gap metabolic acidosis?

hyperchloremic acidosis

Study These Flashcards
A
  • GI bicarb loss (diarrhea, pancreatic fistulas)
  • renal bicarb loss (carbonic anhydrase inhibitors)
  • reduced renal H+ excretion
  • acid administration (TPN)
21
Q

What are the causes of anion gap metabolic acidosis?

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A
  • methanol intoxication
  • uremia
  • lactic acidosis
  • ethylene glycol
  • paraldehyde ingestion
  • aspirin (salicylates)
  • ketoacidosis

MULEPAK

22
Q

What are the signs and symptoms of metabolic acidosis?

Study These Flashcards
A
  • nausea/vomiting
  • deep, rapid breathing
  • hyperkalemia
23
Q

How is metabolic acidosis treated?

Study These Flashcards
A
  • treat underlying cause
  • acute bicarb therapy
24
Q

How is bicarb therapy dosed?

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A
  • Dose (mEq) = [0.5 L/kg (IBW)] x (desired HCO3 - actual HCO3)
  • Give 1/3 to 1/2 of the calculated dose

desired HCO3 = 12

25
What are the steps for evaluating metabolic acidosis?
- calculate anion gap - if gapped, calculate delta gap - add delta gap to HCO3 - If that value is elevated, the patient has metabolic alkalosis on top of metabolic acidosis
26
What are the subtypes of metabolic alkalosis?
- saline responsive (urinary chloride <20 mEq/L) - saline resistant alkalosis (urinary chloride > 20 mEq/L)
27
What are the causes of saline responsive metabolic alkalosis?
- diuretic therapy (loops + HCTZ) - vomiting
28
What are the causes of saline resistant alkalosis?
- excess mineralocorticoid activity - hypokalemia - Bartter's syndrome
29
What are symptoms of metabolic alkalosis?
- muscle cramps - dizziness
30
What are the treatment options for saline-responsive metabolic alkalosis?
- fluid/electrolyte replacement - carbonic anhydrase inhibitors
31
What are the treatment options for saline-resistant metabolic acidosis?
- correct hypokalemia - decrease mineralocorticoid dose - administer spironolactone - correct hyperaldosteronism
32
What is respiratory acidosis characterized by?
- low pH - increased CO2 (>45)
33
What are the causes of respiratory acidosis? | almost always a failure of excretion
- airway obstruction - reduced breathing stimulus - failure of heart or lungs (PE) - neuromuscular defects impeding ventilation - mechanical ventilation
34
What are the symptoms of respiratory acidosis?
- SOB - drowsiness, coma - tachycardia, hypotension
35
What are the treatment options for respiratory acidosis?
- correct underlying cause - mechanical vent or oxygen
36
What is respiratory alkalosis characterized by?
- increased pH - decreased CO2 (<40)
37
What are the causes of respiratory alkalosis?
- CNS stimulation of breathing (anxiety, pain) - peripheral stim of breathing (hypotension, hypoxemia) - mechanical vent - salicylate intoxication
38
What are the symptoms of respiratory alkalosis?
- dizziness, confusion - decreased cerebral blood flow - muscle cramps
39
What are the treatment options for respiratory alkalosis?
- correct underlying cause - ventilation, sedation, paralysis
PHRM 864
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