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38 Cards in this Set

  • Front
  • Back
what causes respiratory acidosis?
depression of respiratory center by cerebral disease or drugs
neuromuscular disorders
cardipulmonary arrest
collagpse of lung
impaired diffusion of CO2 (blood to alveoli)
what happen is respiratory acidosis?
hypercapnia due to hypoventilation resulting in increased pCO2 and H+
what causes chronic respiratory acidosis:
obstruction of airway (chronic emphysema and bronchitis)
impaired diffusion of CO2
how is respiratory acidosis compensated?
by kidneys via increased excretion of H+
how do you treat respiratory acidosis
improve ventilation by treatin underlying cause: mechanical ventilation
what is respiratory alkalosis?
hypocapnia due to hyperventilations resilting in lowered pCO2 and decreased H+
what causes respiratory alkalosis
hypoxia, anxiety, strenuous exercise, feer, sepsis, respiratory center lesions, high altitude, salicylate poisoning
how is respiratory alkalosis compensated?
by kidneys via lowered bicarbonate recovery/production at proximal tubule and distal and collecting duct (intercalated and principal cells)
how to tx respiratory alkalosis
treat underlying cause; breathe CO2
what is metabolic acidosis?
excessive H+ or decreased HCO3-, primary deficit: HCO3-, consequence: blood pH is decreased
potential causes of metabolic acidosis
abnormal metabolic processes in body (disease state)
drug-induced (toxins: salicylates, methanol, ethylene glycol)
kidney dysfunction: usually due to renal failure
how is metabolic acidosis compensated?
increased ventilation (hyperventilation) and CO2 removal, this is rapid as long as pulmonary function is GOOD
how do you tx metabolic acidosis
treat underlying cause, which can be aided by ANION GAP measurement
what is anion gap?
what is metabolic alkalosis?
decreased H+ or increased HCO3-, primary increase in HCO3-, increased pH
what are the causes of metabolic alkalosis
excessive gain of bicarbonate or alkali (excessive use of antacids or solns containing acetate, citrate, lactate)
excessive loss of H+ (vomiting, binge-purge syndrom)
volume loss (diarrhea, diuretics)
how is metabolic alkalosis compensated?
respiratory compensation vai decreased ventilation (hypoventilation) in response to rising pH, this is rapid as long as pulmonary function is normal
how to tx metabolic alkalosis
tx underlying cause
fluid balance, acid-base balance, renal dysfunction (renal failure)
characteristics of ARF:
rapid onset, rapid decline in renal function (increase blood levels of urinary waste products), electrolyte imbalances
characteristics of CRF:
slow, progressive loss of renal failrue, usually irreversible, permanent loss of structures, no tx, stop progression only
ARF is common in which pts?
those seriously ill pts in ICU
mortality from 40-75%
common indicator of ARF?
what conditions cause ARF?
decreased blood flow w/o ischemic injury
tubular injury
obstruction of urinary tract outflow
what are the 3 types of ARF?
prerenal, intrinsic or intrarenal and postrenal
what is the primary cause of prerenal ARF?
impaired renal flow, reversible if cause is IDed and corrected before damage
what are causes of impaired renal blood flow in prerenal ARF?
hypovolemia: hemorrhage, dehydration
decreased vascular filling: septic shock, anaphylactic shock
decreased renal perfusion from drugs
what are S&S of prerenal ARF:
sharp decrease in urine output (oliguria)- decreased sodium concentration suggests decreased renal perfusion, as body attempts to perserve sodium to perserve vascular volume
disproportionate elevation of blood urea nitrogen (BUN) in relation to serum creatinine
normal 10:1 (BUN: serum creatinine)
elevated 15:1 or 20:1
how to tx prenal ACF?
ID cause and get them to PPEEEEEEEEEEEEE
what is the cause of postrenal ARF and potential sites?
obstruction of urine output: ureter, bladder, urethra
what are the causes of inrinsic or intrarenal ARF?
conditions damaging to structures within kidney: ischemia associated wtih prerenal failure, toxic insult to tubular structure of nephron, intratubular obstruction
intrarenal ARF are classified to which 3 sites?
what is intrarenal ARF characterized by:
destruction of tubular epithelial cell with acute suppression of renal function
what are the 3 phases of ATN (acute tubular necrosis)
onset or intiating phase, maintanence phase (oliguric < 400mL/day, nonoliguric), recovery (diuresis) phase
what are the causes of ATN (acute tubular necrosis)
acute tubular damage from ischemia (no improvement of GFR with flow restoration), nephrotoxic effects of drugs, tubular obstruction, toxins from massive infection
how is ARF diagnosed and txed?
diagnosis: prevention and early diagnosis best b/c high morbidity and mortalitiy associated with ARF, assess and ID peeps at risk
tx: ID and correct cause, fluids carefully regulated
what is CRF:
progressive, irreversible destruction of kidney structures, dialysis and transplatation has improved mortality
what are causes of CRF?
anthing that causes permanent loss of nephron- diabetes, HTN, glomerulonephritis)
what are stages of CRF progression?
renal insufficiency, renal failure, end-stage renal disease