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45 Cards in this Set
- Front
- Back
what do you evaulate to determine the pathophysiology of acid/base changes? |
bicarbonate and arterial carbon dioxide |
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in general do cellular reactions create acid or base? how do we deal with the formation of that? |
acid direct excretion or produce bicarbonate |
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where is bicarbonate reabosrbed? by what enzyme? |
PCT carbonic anhydrase |
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are free H+ excreted in urine? |
no the combine and from ammonium or phosphoric acid which gets secreted |
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how dose ph adjustment vary when comparing renal and pulmonary? |
much faster pulmonary, by adjusting pulmonary rate renal ajustment takes days |
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what is normal pH? normal hco3? normal pco2? |
7.35-7.45 22-26 35-45 |
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where is blood for arterial blood gas testing taken from? how does the bicarb from a chem 7 differ from the ABG test? |
-radial it is 2-3 lower than abg |
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what generally causes respiratory acidosis and alkalosis? |
distrubance in the arterial c02 concentration, results in metabolic compensation |
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what exactly causes respiratory acidosis? |
respiratory insufficiency which results in increased arterial c02 |
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what exactly causes respiratory alkalosis? |
hyperventilation resulting in a decreased c02, results in decreased serum bicarb |
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what genearlly cuases metabolic acidosis and alkalosis? |
disturbances in serum bicarb concentration |
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how is metabolic acidosis corrected? |
increase in ventilation |
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how do you correct metabolic alkalosis? |
loss of fluid that is low in bicarb or add bicarb, decreases in ventilation |
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what is a simple acid base disorder? what is mixed acid base disorder? |
a single isolated acid base disorder,there is only a single problem that is causing the issue the simultaneous presence of more than one acid base disorder, could be many culprits contributing |
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why are respiratory disorder considered acute or chronic? why are metabolic acid base disorders always chronic? |
c02 is a rapidly volitle acide and can be rapidly changed by the the respiratory system, acid base issue can remain for minutes or days, making it chronic or acute metabolic machinery that regulates in bicarb result in slow changes, and thus is considered chronic |
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what is compensation? |
changes that follow the primary disorder and attempt to resotre the blood pH to normal |
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what does the body do in chronic respiratory acidosis? what does the body do in chronic respiratory alkoalosis? |
increase bicarb decrease bicarb |
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explain how acid base disorders are diagnosed? |
look at ph, then pco2, then hco3, assess compensation, calculate anion gap, caluclate excess gap |
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serum is isoeletric but ions in the serum are not equal, why? is there more cations or anions measured? what is a healthy anion gap? |
only measuring certain eletolytes and negative proteins, phosphates and sulfates are not measured or other positive charges like mg or ca cations (10-12) higher 10-12 |
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what does an anion cap greater than 12 suggest? why is there an increase in anions |
accumulation of unmeasured anions which indicated metabloic acidosis H will jump off acid and form co2 and water with while conjugate base will be left in blood with a neg charge, this represents a loss in bicarb which equals increasing acid |
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define excess gap? |
amoount of bicarb that has been lost due to buffering unmeasured cations |
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in general how should you treat acid base disorders? |
treat underlying cause and support the treatment of ph and electrolytes until underlying disease is improved |
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what are the causes of anion gap metabolic acidosis? |
MUDPILES methanol to formaldehyde then formic acid uremia- renal failure accumation of po4 and so4 DKA paraldehyde isoniazid- treats TB lactic acidosis ethylene glycol salicylate od |
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what are the two types/causes of lactic acidosis? |
A- tissue hypoxia- hypotension, sepsis, anemia, shock B- impared lactate clearance-liver disease, metformin, diabetes, cancer |
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acid base disorders with the highst anion gaps are? |
ketoacidosis, lactic acidosis, methanol or ethylene glycol ingestion |
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what is normal anion gap metabloic acidosis also called? what is the most common cause? |
non-gap or hypercholermic because cl is very high diarrhea- loss of bicarb, others included carbonic anyhdrase inhibitors or adrenal insufficency |
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signs and symptoms of metabolic acidosis? |
hyperventilaiton, decrease cardiac function, lethargy |
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how do you treat metabolic acidosis? |
iv sodium bicarb 1 meq/kg, for severe acidosis pH 7.1, or kidney failure |
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why would you use sodium citrate over sodium bicarb? |
citrate is convereted to bicarb and does so with less na as compared to sodium bicarb |
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what are the two types of metabolic alkalosis and how are they created? |
cl responsive- loss of chloride rich and bicarb poor fluid from diuretics or vomiting cl nonresponsive- excess mineralocorticoid activity |
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what two things need to be present for alkalosis to occur? major symptom of alkalosis? |
concurrent loss of acid and impairment of renal bicarb excretion hyperkalemia |
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what can determine if your nacl responsive or non responsive? |
low urinary cl is responsive high urinary cl is resistant |
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how do you treat metabolic alkalosis? what do you give a patient needs to take a diuretic or is nacl resistant? |
nacl if responsive acetazolamide to maintain ph by inhibiting CA and holds on to H+ |
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what do you give for severe metabolic alkolosis? what do you give to a patient if they have metabolic alkolsis from ng suction? |
0.1 HCL 100 ml/hr h2 antagonists |
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what is therapy for a nacl resistant metabolic alkolosis? |
decrease steriod dose or switch to less mineralcorticioid activity, adrenalectomy, or spirnolactone |
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what is compensation for respiratory acidosis? |
kidneys increase bicarb production and h excretion |
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how do you treat respiratory acidosis? |
provide adequate ventilation, 02, sodium bicarb |
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how does compensation work for respiratory alkolosis? |
decrease bicarb reabosption in PCT |
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signs and symptoms of respiratory alkolosis? |
lightheadedness, confusion, arrhythmia, n/v, decrease po4, k, ca |
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treatment of respiratory alkoloiss? |
02 therapy, mechanical ventialtion |
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when can you suspect mixed acid base disorder? |
normal ph with abnormal bicarb or pco2 |
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what would respiratory and metabolic acidosis look like? what would cause it? |
very low ph cardiorespiratory arrest, copd in shock, metabolic acidosis who develop respiratory failure |
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what would respiratory alkalosis and metabolic alkoosis look like? what would cause it? |
very high ph hypotensive and on ventilator with vomiting and ng suctioning |
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what would metabolic acidosis and respiratory alkalosis look like? what causes it? |
normal ph, why you look at things beyond ph liver disease, asa tox, pulmonary renal syndromes |
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what would metabolic alkalosis and respiratory alkalosis look like? what causes it? |
normal ph copd treated with na restriction or diuretic |