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acid base lecture
acid base lecture notes
| Question | Answer |
|---|---|
| Acid | - donates a proton; releases H+ H+ + Cl- = Hydrochloric acid Too much H+ Acidemia - blood Acidosis-overall condition in body fluids When acid meets base…they neutralize! When acid meets base…they neutralize! |
| Base | accepts or combines with a proton Na++ OH- = Sodium Hydroxide Too much base Alkalemia - blood Alkalosis- overall condition in body fluids |
| Clinical Manifestations of alkalosis | Death convulsions arrhythmia irritability |
| Clinical Manifestations of acidosis | drowsiness lethargy coma |
| Blood Buffers | Acids are carried by Hb and HCO3 (88%) Bicarb system is open, primary system Due to loss of CO2 through breathing HC03 + H+ = H20 + CO2 (exhaled) Nonbicarb systems are closed Nothing is “lost” Hemoglobin, phosphates, proteins |
| Henderson-Hasselbach Equation | Allows you to calculate pH, CO2, or HCO3 if you know 2 of the 3 variables in the formula Use: to check if pH, PCO2, and HCO3 in an ABG report are compatible, and to predict what happens when you change one component in the ABG |
| CO2 excretion depends on: | Perfusion Diffusion Ventilation Think heart, lungs or CNS |
| Respiratory Acidosis Clinical signs | hypoxemic manifestations, warm flushed skin, bounding pulse, arrhythmias, > ICP, headaches, <Cl- |
| Respiratory Acidosis Causes | acute airway obstruction massive PE drugs (sedatives, narcotics) neuromuscular disease trauma (brain, spinal cord, chest wall) obesity kyphoscoliosis COPD cardiac arrest |
| Respiratory Alkalosis | Terms: excess CO2 elimination, hypocapnia, hyperventilation Compensation: kidneys excrete HCO3 acute: -PaCO2 by 5 = HCO3 - by 1 (24-48 hrs) chronic: -PaCO2 by 10 = HCO3 - by 5 |
| Respiratory Alkalosis Clinical signs | tachypnea, dizziness, light-headedness, sweating, paresthesia |
| Respiratory Alkalosis Causes | hypoxemia anxiety fever stimulant drugs pain brain tumor sepsis exercise early onset asthma pneumonia, pulmonary edema, CHF iatrogenic (vent, IPPB |
| Metabolic Acidosis Clinical signs | hyperpnea, Kussmaul’s resp.in severe diabetic ketoacidosis, dyspnea, headache, N/V, lethargy, coma (severe) |
| Anion Gap | Helps indicate the cause of metabolic acidosis Anion gap = Na+ - (Cl- + HCO3) Normal: 9 to 14 mEq/L Increased (>14) = metabolic acidosis is caused by an increase in fixed acids Normal anion gap = metabolic acidosis is caused by loss of HCO3 |
| Anion Gap Metabolic Acidosis | Due to increased fixed acids Causes: Diabetic ketoacidosis Lactic acidosis Alcoholic ketoacidosis Advanced renal failure Ethylene glycol intoxication Methanol intoxication (formic acid) Salicylate intoxication (aspirin) |
| Metabolic Alkalosis | Usually accompanied by hypokalemia -Common in ICU; difficult to treat Compensation: hypoventilation but usually uncompensated : lower RR, apnea, cyanosis, N/V, confusion, headache, lethargy, tetany in severe cases |
| Metabolic Alkalosis Causes | NG suction Diuretics Vomiting Steroids Hypokalemia Hypochloremia Hypovolemia NaHCO3 infusion Excessive antacids or alkali for peptic ulcers Posthypercapnic met. alkalosis Massive blood transfusion (>8 units) |
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meyoufools
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