Ap Ii Acid-Base

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AP II ACID-BASE

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AP II ACID-BASE

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Henderson-Hasselbalch Eqtn

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pH = pKa + log [HCO3-/CO2]

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Acid definition according to Arrhenius?

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Releases H+ ions into solution.

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Bronsted-Lowry?

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Donating H+ ions

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Lewis?

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Accepting a pair of electrons from a base.

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Respiratory and Metabolic Acidosis

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PaCO2 > 45

HCO3 < 22

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Acidemia

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pH < 7.35

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Respiratory and metabolic alkalosis

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PaCO2 < 35

HCO3 > 26

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Alkalemia

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pH > 7.45

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What's an Anion Gap?

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The difference between the sum of the major anions and the major cations.

GAP = Na + K - Cl + HCO3

140 + 5 - [105 + 25] = 15

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Normal Blood Gas at sea level

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PaO2: 75-100 mmHg

PaCO2: 35-45 mmHg

pH: 7.35-7.45

SaO2: 94-100%

HCO3: 22-26 mEq/L

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CO2 can also be determined by?

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Venous Blood Gas

ETCO2 (also a qualitative CO monitor). High CO2 means more blood to lungs--> more CO2 into lungs--> higher ETCO2.

Transcutaneous CO2

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Three ways in which pH can be regulated?

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1. body buffers
2. respiratory control
3. renal control

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Phosphate buffer

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Important as a urinary buffer

Low in the ECF

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Bicarbonate buffer

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H+ + HCO3 <--> H2CO3 <--> H2O + CO2

Apply Le Chatlier's Principle

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Laparoscopic surgery can cause?

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Respiratory acidosis

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What diseases can result from respiratory acidosis?

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1. MH
2. adrenal excess
3. thyroid storm

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Describe the anion gap for metabolic acidosis.

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ACID GAIN

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Describe the non-anion gap for metabolic acidosis.

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BICARB LOSS

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Diseases that can lead to Metabolic acidosis acid gain?

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1. lactic acid

2. keto-acidosis (diabetes type I, starvation, alcohol associated)

3. toxic ingestions

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What are some examples of toxic ingestions that can lead to metabolic acidosis acid gain?

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1. methanol
2. ethylene glycol
3. aspirin
4. toluene inhalation (gasoline)

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What can cause an increase of lactic acid?

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1. shock
2. seizures
3. exercise

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One way to treat Acid Gain is by treating?

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Treat Shock

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What is produced when blood level of insulin is zero for about 30 mins?

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Ketones leading to ketoacidosis.

The body fails to adequately regulate ketone production causing such a severe accumulation of keto acids that the pH of the blood is substantially decreased.

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What is the treatment of Acid Gain caused by toxic ingestion?

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Toxic ingestion of methanol and ethylene glycol as examples.

These reactions require alcohol dehydrogenase. Therefore, blocking alcohol dehydrogenase will treat it.

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How do you treat toxic ingestion of aspirin?

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1. alkalinization of plasma and urine.

2. charcoal decontamination

NOTE: 10-30g will kill an adult.
Salicylic acid is product of aspirin.

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Consequences of toluene ingestion?

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1. initially, toluene is converted to hippuric acid and causes an anion gap.

2. eventually all excreted through kidney with Na and K causing Hypovolemia and Hypokalemia.

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Causes of bicarb loss?

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1. diarrhea
2. Type 2 (proximal) Renal Tubular Acidosis (RTA)
3. carbonic anhydrase inhibitor
4. chronic kidney disease
a. Type I RTA
b. Type 4 RTA

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What is RTA?

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Metabolic acidosis as a result of inability to reabsorb filtered bicarb and excrete H+ within ammonium.

Net retention of HCL

Net loss of NaHCO3

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What are the 3 types of RTA?

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1. distal or Type I

2. proximal or Type II

3. hypoaldosteronism or Type IV

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Type 1 RTA

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Defect in the distal portion

Can't excrete daily acid load, but wastes bicarb in the urine.

Urine pH >5.5

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NOTE: pH levels for:
Blood: 7.35-7.45
Stomach: 1-3
Duodenum: 6-6.5
Jejunum: 7-8
Large intestine: 5.5-7
Urine: 4.4-8

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.

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Type 2 RTA

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Proximal portion is defective

Can save some bicarb but not as efficient.

pH < 5.5

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Type 4 RTA

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Aldosterone deficiency

Hyperkalemia leads to suppression of ammonia excretion.

Urine pH < 5.3

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Treatment for Type 1 and 2?

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Give bicarb

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Treatment for Type 4

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Give mineralocorticoid

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Metabolic alkalosis

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1. volume contraction results in Na avidity

2. bicarb is excreted normally as Na or K

3. can use carbonic anhydrase inhibitors to excrete bicarb

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Climbing Mt. Everest example exemplifies what disorder?

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Respiratory alkalosis