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111 Cards in this Set

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ABG
Arterial Blood Gases
Normal range for Carbon Dioxide?
24-30 mEq/L
How is the total carbon dioxide determined?
By acidifying serum to convert all bicarb (HCO3-) to carbon dioxide (CO2)
What percentage of serum CO2 is converted bicarbonate?
95%
What organ regulates bicarbonate?
kidneys
What organ regulates CO2?
lungs
What is the main cause of hypercapnia?
Chronic obstructive pulmonary disorder
COPD
chronic obstructive pulmonary disorder
What is the main cause of Hypocapnia?
hyperventilation
Define Acid
A substance that can donate protons (Hydrogen ion, H+)
Define Base
a substance that can accept protons (hydrogen ions)
FACT: All basses are alkaline substance
*Make sure you remember this*
Identify the acid:

HCL --> H+ + Cl-
HCl
Identify the base:

NH3 + H+ --> NH4+
NH4+
Define pH
A measurement indicating body's acid-base balance; quantifies the acidity of body fluids
Definition: A measurement indicating body's acid-base balance; quantifies the acidity of body fluids
pH
Acidemia
acid concentration of the blood (pH <7.35)
Alkalemia
alkaline concentration of the blood (pH > 7.45)
Acidosis
process that lowers pH
Alkalosis
process that increases pH
Alkalosis
process that increases pH
What is the normal pH of arterial blood? (range)
7.35-7.45
What is the main organ system regulating gas exchange and arterial partial pressure of carbon dioxide? (paCO2)
lungs
CO2 diffuses from ______ to __________ and from ____________ into _________ where it is exhaled from the body by the lungs.
tissues; capillary blood; pulmonary capillaries; alveoli; lungs
____ and ____ combine to form H2CO3.
CO2 and H2O
What enzyme catalyzes the formation of H2CO3?
Carbonic anhydrase
Dissociation of _____ to ______ is an important part of the extracellular buffering system.
H2CO3; HCO3-
Name three intracellular/extracellular buffers.
1. serum proteins
2. inorganic phosphates
3. hemoglobin
What organ regulates reabsorption of HCO3- and the excretion of H+
kidneys
How is pH maintained?
through regulatory actions of the lungs and kidneys
How is pH maintained?
through regulatory actions of the lungs and kidneys; also maintained through buffers
What equation describes the relationship between the pH and the concentration of the acid-base concentration?
Henderson-Hasselbach equation
The Henderson-Hasselbach equation describes the relationship between the _____ and the concentration of the _______/_______ concentration.
pH, acid/base
What is the Henderson-Hasselbach equation? (actual equation)
pH = pKa + log(base/acid)
What is the rewritten H-H equation for the HCO3-H2CO3 system?
pH = 6.1 + log (HCO3-/0.03 * pCO2)
What sets the pH?
ratio of the bicarbonate and carbon dioxide (not absolute values)
Define O2 saturation
Definition: Percentage that represents the ratio of the amount of O3 that hemoglobin IS carrying to the amount of O2 that hemoglobin CAN carry
What is the format of ABG:

_/_/_/_/_
pH/pCO2/pO2/HCO3-/O2saturation
Normal ABG values for pH?
7.35-7.45
Normal ABG values for pCO2?
35-45 mmHg
Normal ABG values for pO2?
80-100 mmHg
Normal ABG values for HCO3-?
24-30 mEq/L
Normal ABG values for O2 saturation?
95% or greater
What is the normal range of venous total CO2?
24-28mEq/L
What do arterial samples tell the physician?
provides information abouthow well the lungs are oxygenating the blood (PaO2)
Normal range for Anion gap?
3 - 11 mEq/L
AG
Anion Gap
Why is the anion gap calculated?
When metabolic acidosis is present, anion gap should be calculated to try to determine the cause of metabolic acidosis
T/F: You can have metabolic acidosis with a normal anion gap?
True
Formula for Anion Gap?
Anion Gap = (Na+) - (Cl- + HCO3-)
What does anion gap count for?
the difference between the sum of the measured cations and the sum of the measured anions
What does the result (number) of the anion equation represent?
the amount of extracellular anion needed to offset the positive charge of sodium and potassium and to maintaine electroneutrality
Increased anion gap is valuable in determining the cause of ___________________.
metabolic acidosis
Mneumonic device for common causes of high anion gap?
MULEPAK
Common causes of Low anion Gap?
Multiple myeloma
Major hypercalcemia
Lithium toxicity
M in MULEPAK
Methanol ingestion
U in MULEPAK
Uremia
L in MULEPAK
Lactic acidosis
E in MULEPAK
Ethylene glycol ingestion
P in MULEPAK
Paraldehyde ingestion
A in MULEPAK
Aspirin intoxication
K in MULEPAK
Ketoacidosis
Common causes of high anion gap? (mneumonic)
MULEPAK
PLEASEEEEEEEEEEEEEEEEEEEEEEEE READ THE ACID/BASE CHAPTER!!!!!
ITS VERY VERY IMPORTANT SAYS DR. MORRIS!!! AT LEAST STUDY THE HANDOUT ON THIS SECTION!! KNOW IT WELL! THANKS!!
Two ways to return abnormal pH toward normal?
Compenasation or corrections
Define Compensation
Definition: Abnormal pH is returned toward normal by altering the component NOT primarily affected
Define Correction
Definition: Abnormal pH is returned toward normal by altering the componet primarily affected
In compensation, if pCO2 increases, the _____ will increase _____ reabsorption to bring the pH toward normal
kidneys;HCO3-
In compensation, if HCO3- decreases, the ______ will respond by blowing off _______ to bring pH toward normal
lungs;CO2
List some causes of Metabolic Acidosis
-overproduction of acid: ketoacidosis, lactic acidosis
-administration of acid(as in TPN)
-undersecretion of acid load: renal insufficiency
-HCO3 loss: diarrhea, renal tubular acidosis
Signs and Symptoms: thirst, SOB, weakness, dehydration, tachypnea, restlessness, impaired consciousness,coma
Metabolic acidosis
List s/s of metabolic acidosis
Signs and Symptoms: thirst, SOB, weakness, dehydration, tachypnea, restlessness, impaired consciousness,coma
Laboratory findings: blood pH, pCO2 and serum HCO3 low, anion gap may or may not be elevated, BUN, Scr may reflect degree of renal impairment due to dehydration, increased K+ and Ca2+, ketone bodies in urine and serum with diabetic or alcoholic ketoacidosis
metabolic acidosis
List some lab findings of metabolic acidosis
Laboratory findings: blood pH, pCO2 and serum HCO3 low, anion gap may or may not be elevated, BUN, Scr may reflect degree of renal impairment due to dehydration, increased K+ and Ca2+, ketone bodies in urine and serum with diabetic or alcoholic ketoacidosis
Etiologies: acid loss, bicarbonate gain, hypokalemia, increased anion gap
metabolic alkalosis
Etiologies of metabolic alkalosis
Etiologies: acid loss, bicarbonate gain, hypokalemia, increased anion gap
Metabolic acidosis vs. Metabolic alkalosis
lowered blood ph and bicarbonate; increased ph and increased bicarbonate conc.
Causes of increased anion gap
-loss of H+
-incease in negative charge of plasma proteins
-ECF volume deficit
-increased concentration of the plasma proteins
Compensatory mechanism: extracellular buffering by HCO2, renal H+ excretion, hyperventilation to decrease pCO2
METABOLIC ACIDOSIS
Compensatory mechanism of Metabolic acidosis
Compensatory mechanism: extracellular buffering by HCO2, renal H+ excretion, hyperventilation to decrease pCO2
Compensatory mechanism of metabolic alkalosis
Compensatory mechanisms: hypoventilation to increase pCO2, H+, reabsorption by kidneys
Compensatory mechanisms: hypoventilation to increase pCO2, H+, reabsorption by kidneys
metabolic alkalosis
S/S: impaired mentation, hypotension, cardiac arrhythmias, hypoventilation, weakness and hyporeflexia if K+ is low
metabolic alkalosis
S/S of metabolic alkalosis
S/S: impaired mentation, hypotension, cardiac arrhythmias, hypoventilation, weakness and hyporeflexia if K+ is low
Lab findings of metabolic alkalosis
Lab findings: arterial blood ph>7.45, increased HCO2, increased arterial pCO2, increased anion gap may be present
Lab findings: arterial blood ph>7.45, increased HCO2, increased arterial pCO2, increased anion gap may be present
metabolic alkalosis
Etiologies of respiratory acidosis
Etiologies:
-CNS depression (impaired resp. drive)
-Neuromuscular disorders (trauma, stroke, brain stem injury)
-Pulmonary disease: pneumonia, smoke inhalation
Etiologies:
-CNS depression (impaired resp. drive)
-Neuromuscular disorders (trauma, stroke, brain stem injury)
-Pulmonary disease: pneumonia, smoke inhalation
respiratory acidosis
Another name for respiratory acidosis
hypoventilation
Compensation mechanisms for respiratory acidosis (acute response)
Compensation mechanisms (acute response):
-increase in pco2 results in inc. carbonic acid levels
-carbonic acid dissociates, relasing H ions which are buffered by nonbicarbonate buffers and also by bicarbonate
Compensation mechanisms for respiratory acidosis (renal response)
HCO3 retention (may take several days to fully compensate)
~ how long does it take the renal (metabolic) response to compensate for respiratory acidosis?
may take serveral days to compensate
S/S of respiratory acidosis
s/s: somnolence, confusion, asterixis, SOB, cyanosis, hypertension, tachycardia
s/s: somnolence, confusion, asterixis, SOB, cyanosis, hypertension, tachycardia
respiratory acidosis
What is somnolence?
REAL SLEEPY
What is asterixis?
hand tremors
Lab findings for respiratory acidosis
Lab findings: arterial blood pH is decreased, pCO2 increased, serum HCO3 is elevated by not enough to completely compensate for the hypercapnia
Lab findings: arterial blood pH is decreased, pCO2 increased, serum HCO3 is elevated by not enough to completely compensate for the hypercapnia
respiratory acidosis
Respiratory acidosis vs respiratory alkalosis
decreased ph, increased pCO2 VS. increased ph, decreased pCO2
What is another name for respiratory alkalosis?
hyperventilation
Etiologies of respiratory alkalosis
Etiologies: anxiety, hypoxemia, pulmonary disease, liver disease, gram negative sepsis, incorrectly used mechanical ventilator, pregnancy, drugs
Etiologies: anxiety, hypoxemia, pulmonary disease, liver disease, gram negative sepsis, incorrectly used mechanical ventilator, pregnancy, drugs
respiratory alkalosis
Acute compensation mechanism for respiratory alkalosis
Acute compensation mechanism: chemical buffering - H+ ions are released from the bodys buffers - intracellular proteins, phosphates and hemoglobin which decreases the serum bicarb conc.
Acute compensation mechanism: chemical buffering - H+ ions are released from the bodys buffers - intracellular proteins, phosphates and hemoglobin which decreases the serum bicarb conc.
respiratory alkalosis
Metabolic compensation mechanism: occurs when [disease state] persisists for more than 6-12 hours; bicarb reabsorption is inhibited and serum bicarb falls, usually complete renal compensation within 1-2 days
respiratory alkalosis
Metabolic compensation mechanism for respiratory alkalosis
Metabolic compensation mechanism: occurs when [disease state] persisists for more than 6-12 hours; bicarb reabsorption is inhibited and serum bicarb falls, usually complete renal compensation within 1-2 days
How long does respiratory alkalosis persist before metabolic compensation mechanisms occur?
6-12 hours
S/S of respiratory alkalosis
S/S: hyperventilation, angina, arrhythmias, lightheadedness, anxiety, tingling sensation, numbnessa round the mouth, N/V
S/S: hyperventilation, angina, arrhythmias, lightheadedness, anxiety, tingling sensation, numbnessa round the mouth, N/V
respiratory alkalosis
Lab findings for respiratory alkalosis
Lab findings: increased pH, low pCO2, decreased serum HCO3-
Lab findings: increased pH, low pCO2, decreased serum HCO3-
respiratory alkalosis