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27 Cards in this Set
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14 y/o pH 7.27/PCO2 = 27/ HCO3 = 12
Na = 145, cl = 105 acid base status metabolic/respiratory pure or complicated anion gap |
acidemic
primary - metabolic Winters - compenstated PCO2 = 1.5(HCO3)+8+/-2 = 1.5(12)+8 = 26 pure anion gap = Na- (Cl +HCO3) = normal 10 hers 145 - (105 + 12) = 28 |
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acidemia /alkalemia pH
normal HCO3 normal PCO2 |
acidemic pH<7.37
alkalosis pH > 7.42 HCO3 = 24 PCO2 = 40 |
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why is "compensated" acid/base disturbance a bad term?
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normal physiologic response is better
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anion gap mnomonic
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mud piles - new (KumiLes)
methanol - will almost never see this Uremia (BUN ~>100) - won't see this often. If they pee probably will be normal dka ** - don't give bicarb, fix acid base problem. also other ka (e.g. alcoholic). give D5NS vs. NS so that they have something to metabolize. paraldehyde - won't see this phenformin (phen phen) - removed market but cousin is metformin iron - INH - give paradoxime ****lactic acidosis - ethelene glycol salcilate |
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glucose 450. how do you manage?
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*order 2-3 Ls of NS fluid in first few hours because of glucose diuresis
* insulin drip = .1units/KG -> reduces gap by moving ketones into cells so that they can be. keep insulin going until gap is gone. if glucose is low (<200) add glucose plus insulin. * no insulin bolus * chem 7 every 2 hours to follow gap - follow bicarb * serum acetone - follows ketones |
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7 y/o w/ pH 7.27/PCO2 = 27/ HCO3 = 12, Na 142, cl = 120
anion gap tx: |
ag = 142 - (120+12) = 10 = normal = non anion gap acidosis
tx: bicarb = bicarb deficit mequivalents = (tot body water (L))(delta bicarb) (30kg x .6)(24-12) = 216 meq -> give 1 amp bicarb (50meg/amp) w/ NS |
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non anion gap acidosis mnumonic
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hard up
h = hyperventilation - A = altitude/acetezolemide - take when they go to altitude - causes urine to waste bicard to cause you hyperventilate R = renal tubual acidosis D = diarrhea **** U = ureter problems post surgery P = pancreatic fistulas |
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24 y/o w/ ph = 7.08/ pco2 = 38 / hco3 = 12
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acidemic
metabolic winters - 1.5*(12) + 8 = 26 actual pco2 = 38 not pure. also has respiratory acidosis |
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mixed respiratory and metabolic acidosis ddx
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* after resucitation - havent been breathing or perfusing. wait a few minutes after resucitation before taking labs
* seizure - don't breath and have lactic acidosis - wait a few minutes * dieing patients |
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72 y/o pnuemonia. ABG: 7.36/20/12
what acid base disturbance ddx |
metabolic acidosis
winters PCO2 = 1.5(12)+8 = 26 actual pco2 = 20 not compensated mixed metabolic acidosis/ respiratory ALKALOSIS - PT is breathing too fast ddx: aspirin (think of in kids) *pending sepsis * fulminant liver failure |
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HCO3 less than what must be worked up?
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<20 must be explained before you go to bed
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57 y/o asthma/COPD exacerbation
ABG: 7.24/60/ |
respiratory acidosis
can't use winters because not metabolic primary pH_predicted = -0.08(delta PCO2) +7.4 = -0.8(60-40) + 7.4 = 7.24 pure respiratory acidosis tx: - nebs - consider transfering to ICU |
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at what PCO2 should you transfer to the ICU?
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transfer to ICU if >70
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32F pregnant w/ SOB and fatigue
ABG: 7.52/35/28 |
alkalemic
metabolic alkalosis b/c bicarb > 24 path: vomiting gives metabolic alk and SOB -> hypervent -> resp alk winters PCO2= 1.5(28)+8 = 50 PCO2 = 35 metabolic alkalosis and respiratory alkalosis tx: help nausea |
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8 weeks pregnant, vomiting dehydrated, nausea, IV started
ABG: 7.4/42//24 Na = 140, Cl = 90 why bicarb normal |
ag = 140 - (90+24) = 26 ->
metabolic ACIDOSIS!!! and metabolic alkalosis (not acidemic though) why bicarb normal = puking tx: give them something to metabolize. give D5NS to give her something to metabolize. no insulin needed. * gap is being caused by ketones. track ketones to see if she is getting better. Do udip...track ketones |
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small bowel expretion. getting demoral for pain
ABG: 7.38/30/28 na = 150 cl = 95 why PCO2 and HCO3 weird? ddx? tx: |
pH should be high
winters PCO2 = 1.5(28) + 8 = 50 PCO2 = 28 -> respiratory alkalosis ag = 150- (95+28) >10 -> metabolic acidosis high bicarb means respiratory acidosis Therefore: mixed respiratory acidosis, respiratory alkalosis, and metabolic acidosis elevated means ddx: * impending sepsis + NG tube tx: will get worse quickly - get help |
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when do you get an ABG
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post op pt
VBG is not good for PCO2 |
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7.4/19/95
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ph should be higher with low PCO2
winter PCO2 predicted = 30... |
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anion gap
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AG = Na- (Cl + HCO3) >10 abnormal = metabolic acidosis
acidosis is due to something other than H+ |
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winters formula/
PCO2_predicted? |
PCO2_predicted = 1.5(HCO3) +8
if PCO2_actual > PCO2_predicted -> respiratory acidosis if PCO2_actual < PCO2_predicted -> respiratory acidosis |
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what do you think of with mixed metabolic acidosis/ respiratory ALKALOSIS
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pending sepsis b/c of increased lactic acid preduction
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non-anion gap acidosis ddx
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HARD UP
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Metabolic anion gap acidosis ddx
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MUDPILES
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Metabolic alkalosis ddx
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1. emesis, NG tube,
2. hyperadrenocorticoid state, hypomagnesia, hypokalemia |
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pure respiratory alkalosis ddx
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1. increase in estrogen from preggers or early liver failure
2. early sepsis 3. psychogenic hyperventilation 4. assisted ventilation |
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mixed metabolic acidosis and respiratory alkalosis
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1. impending sepsis
2. ASA overdose 3. fulminant liver failure (hyperventilate from estrogen but can't metabolize lactate 4. pulmonary edema |
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mixed metabolic and respiratory acidosis
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1. seizure
2. cardiac arrest |
