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27 Cards in this Set

  • Front
  • Back
What are causes of respiratory acidosis?
• primary pulmonary disease
• neuro-muscular disease
• primary CNS dysfunction
• drug-induced hypoventilation

* all disorders that reduce pulmonary function & CO2 clearance
What are the most common clinical characteristics of respiratory acidosis?
• headache
• drowsiness
How do the kidneys compensate for respiratory acidosis?
• after 2-5 days, kidneys will increase H+ secretion
• increase HCO3 production
What are causes of respiratory alkalosis?
• hyperventilation (most common)
• gram-negative septicemia
• hypoxia
• liver insufficiency
• pregnancy
• primary CNS dysfunction
• salicylate intoxication
What are clinical features of respiratory alkalosis?
• acroparesthesias
• circuoral paresthesias
• giddiness
• light-headedness
• varied breathing pattern (frequent, deep, sighing to sustained, rapid, deep breathing)
How do the kidneys compensate for respiratory alkalosis?
• decrease H+ secretion (holds on to H+)
• decrease in HCO3
• increase of Chloride level
What are causes of metabolic acidosis?
• Diabetic ketoacidosis
• Ethylene glycol ingestion
• Lactic acidosis
• Salicylate intoxication
• Starvation ketosis
What are causes of H+ retention (which can cause metabolic acidosis)?
• adrenal insufficiency
• renal insufficiency
• renal tubular acidosis
What are causes of HCO3 loss and have a normal anion gap?
• diarrhea
• pancreatic or biliary drainage
• ureterosigmoidostomy
What are clinical features of metabolic acidosis?
• hyperventilation (earliest sign)
• ventricular arrhythmias
• neurologic symptoms (lethargy to coma)
What are causes of metabolic alkalosis (at the ion level)?
• loss of H+
• addition of HCO3
• disproportionate loss of chloride
What are clinical features of metabolic alkalosis?
• neurologic symptoms
• volume depletion symptoms
• symptoms of K+ loss
Give examples of neurologic symptoms seen in metabolic alkalosis
• carpopedal spasm
• confusion » stupor » coma
• light-headedness
• paresthesia
Give examples of volume depletion symptoms seen in metabolic alkalosis
• muscle cramps
• postural dizziness
• weakness
Give examples of symptoms seen in metabolic alkalosis due to potassium loss
• muscle weakness
• polyuria
• polydipsia
What is the treatment for metabolic alkalosis?
• IV Normal Saline for vomiting & diuretic induced
• replace K+
What is a potential complication of giving too much fluid in diuretic-induced metabolic alkalosis?
CHF
What is the definition of anion gap?
difference between calculated serum anions and cations
How do you calculate anion gap?
Serum sodium - serum chloride - serum bicarbonate
What are causes of a low anion gap?
• Hyponatremia
• Hypermagnesemia
• Hypoalbuminemia
• paraproteinemia (Multiple Myeloma)
• Spurious hyperchloremia (Bromide toxicity)
What are causes of a high anion gap?
Pneumonic: MUDPILES
• M - Methanol
• U - Uremia
• D - Diabetic ketacidosis
• P - Paraldehyde
• I - Iron, isoniazid (INH)
• L - Lactic Acid
• E - Ethanol, ethylene glycol
• S - Salicylates
What is the normal compensatory change in metabolic acidosis?
PaCo2 decrease 1.2 mmHg per 1mEq/L bicarbonate fall
What is the normal compensatory change in metabolic alkalosis?
PaCO2 increases 6 mmHg per 10 mEq/L bicarbonate rise
What is the normal compensatory change in acute respiratory acidosis?
HCO3 increases 1 meq/L per 10 mmHg PaCO2 rise
What is the normal compensatory response in chronic respiratory acidosis?
HCO3 increases 4 meq/L per 10 mmHg rise
What is the normal compensatory response in acute respiratory alkalosis?
HCO3 decreases 2 meq/L per 10 mmHg PaCO2 fall
What is the normal compensatory response in chronic respiratory alkalosis?
HCO3 decreases 4 mEq/L per 100 mgHg PaCO2 fall