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Acid/Base
| Question | Answer |
|---|---|
| A buffer can act as either a very weak ___ or a very weak ___; it either readily ____ or ____ hydrogen ions | Acid; base; accepts; gives up |
| What is pKa? | The pH at which 50% of the drug is ionized |
| What is the definition of pH? | The negative logarithm of H+ ions |
| The higher the pKa, the ____ the acid | Weaker |
| In terms of local anesthetics, what happens when they are in an alkalotic environment? | They become more non-ionized |
| Why is there less of a risk of aspiration intraoperatively if you allow the patient to drink water preoperatively? | The water will dilute out the gastric secretions in the stomach |
| In an acidotic environment, O2 is ___ tightly bound to hemoglobin, meaning that more O2 will ____ | Less; go to the tissues |
| In an alkalotic environment, O2 is ____ tightly bound to hemoglobin, meaning that less O2 will ____ | More; go to the tissues |
| What is the SID? (Strong Ion Difference) | The sum of dissociated cations (mainly Na+) minus anions (mainly Cl-) |
| ___ influences the H+ ion concentration and is responsible for systems striving toward homeostasis/equilibrium | Electronegativity |
| The two main buffers for acute acid-base changes in the body are ___ and ____ | Bicarb; hemoglobin |
| The two main buffers released by the kidneys are ___ and ____ | Phosphates; ammonia |
| Water dissociates into ___ and ___ ions | H+; hydroxide (OH-) |
| Most OR ABGs calculate on the basis that any change is ___; therefore, the results may be inaccurate for ___ derangements | Acute; chronic |
| Physiologic responses to change in H+ concentration are characterized by the following three phases.... | Immediate chemical buffering; respiratory compensation; slower but more effective renal compensation |
| The bicarbonate system is important partly because there is a ___ concentration of HCO3 in the ECF and PCO2 and plasma HCO3 are regulated by the ___ & ____ | High; lungs; kidneys |
| HCO3 is effective against metabolic, but not ___ acid-base disturbances and changes in HCO3 concentration do not reflect severity of ___ ____ | Respiratory; respiratory acidosis |
| Minute ventilation increases ____ for every acute 1 mm Hg increase in ____ | 1-4 L/min; PaCO2 |
| Respiratory acidosis occurs with PaCO2 > ____ and the pH is < ____ | 44; 7.35 |
| Respiratory alkalosis occurs with PaCO2 < ___ and the pH is > ____ | 36; 7.45 |
| For each deviation in PaCO2 of 10 mm Hg in either direction, ___ pH units change in the ____ direction | 0.08; opposite |
| Metabolic acidosis occurs with HCO3 < ___ and the pH is < ____ | 22; 7.35 |
| Metabolic alkalosis occurs with HCO3 > ____ and the pH is > ____ | 26; 7.45 |
| Compensation is defined as the body's attempt to return the acid-base balance to ____ | Normal |
| If the primary problem is respiratory acidosis, then the compensation is ____ ____ | Metabolic alkalosis |
| If the primary problem is respiratory alkalosis, then the compensation is ____ ____ | Metabolic acidosis |
| If the primary problem is metabolic acidosis, then the compensation is ____ _____ | Respiratory alkalosis |
| If the primary problem is metabolic alkalosis, then the compensation is ____ ____ | Respiratory acidosis |
| In acute respiratory acidosis, the pH decreases ___ units for every 1 mm Hg increase in PaCO2 | 0.008 |
| In acute respiratory acidosis, the HCO3 increases ___ mEq/L per ____ mm Hg PaCO2 | 0.1-1; 10 |
| In chronic respiratory acidosis, the pH decreases ___ units for every 1 mm Hg increase in PaCO2 | 0.003 |
| In chronic respiratory acidosis, the HCO3 increases ____ mEq/L per ___ mm Hg PaCO2 | 1.1-3.5; 10 |
| In acute respiratory alkalosis, the pH increases ___ units for every 1 mm Hg decrease in PaCO2 | 0.008 |
| In acute respiratory alkalosis, the HCO3 decreases ____ units mEq/L per ____ mm Hg PaCO2 | 0-2; 10 |
| In chronic respiratory alkalosis, the pH increases ____ units for every 1 mm Hg decrease in PaCO2 | 0.017 |
| In chronic respiratory alkalosis, the HCO3 decreases ____ mEq/L per ___ mm Hg PaCO2 | 2.1-5; 10 |
| In metabolic acidosis, the PaCO2 drops ____ units per 1 mEq/L drop in HCO3 | 1-1.5 |
| In metabolic alkalosis, the PaCO2 increases ____ units per 1 mEq/L rise in HCO3 | 0.5-1 |
| PaCO2 does not usually increase above ____ mm Hg in response to metabolic alkalosis | 55 |
| What are the three ways that the kidneys can compensate for acidosis? | Reabsorption of filtered HCO3; excretion of titratable acids; production of ammonia |
| If necessary and in times of metabolic alkalosis, the kidneys can excrete large amounts of ___ | Bicarb |
| Metabolic alkalosis typically only occurs with sodium ___ or ____ excess | Deficiency; mineralocorticoid |
| What is base excess? | The amount of acid or base in mEq/L that must be added for blood pH to return to 7.40 and PaCO2 to return to 40 mm Hg at full O2 saturation and 37 degrees C. |
| A positive base excess value represents ____ | Metabolic alkalosis |
| A negative base excess value represents ____ | Metabolic acidosis |
| In severe acidotic states, tissue ___ can occur even with oxygen-hemoglobin dissociation curve shifts to the ____ | Hypoxia; right |
| Acidosis causes K+ ions to move ____ the cells in exchange for ____ ions moving ____ the cells | out of; H+; into |
| What is CO2 narcosis? | CNS depression occurring as a result of respiratory acidosis |
| Why do patients with baseline chronic respiratory acidosis require special consideration? | The patient's drive to breathe is typically dependent on hypoxemia rather than PaCO2; therefore you must be careful when administering supplement O2 to these patients |
| What are the three mechanisms by which metabolic acidosis is initiated? | Consumption of HCO3 by strong non-volatile acid; renal/GI wasting of HCO3; dilution of ECF compartment with HCO3-free fluid |
| How do you calculate the anion gap? | Na+ - (CL- + HCO3-) |
| What is another way of expressing the anion gap? | Unmeasured anions - unmeasured cations |
| An increase in the unmeasured anions or decrease in unmeasured cations ____ the anion gap | Increases |
| Metabolic acidosis associated with a normal anion gap is typically characterized by ____ and results from excessive NS infusion or GI/renal losses of ____ | Hyperchloremia; bicarb |
| Acidosis can ___ the depressant effects of most sedatives and anesthetic agents on the ___ and ____ systems | Potentiate; central nervous; circulatory |
| Because most opioids are weak bases, acidosis can increase the ____ fraction of the drug | Non-ionized |
| Respiratory alkalosis reduces cerebral ___ ___, increases systemic ____ ____, and may precipitate coronary ____ | Blood flow; vascular resistance; vasospasm |
| In the lungs, respiratory alkalosis causes bronchoconstriction but decreases pulmonary ____ _____ | Vascular resistance |
| What is the most common cause of chloride-sensitive metabolic alkalosis? | Diuretics (especially loop and thiazide) |
| What is the second-most common cause of chloride-sensitive metabolic alkalosis? | Loss of gastric fluid |
| The treatment of choice for chloride-sensitive metabolic alkalosis is... | Administration of IV NaCl and KCl |
| Respiratory alkalosis seems to ____ the duration of opioid-induced respiratory ____ due to increased ___ ____ of opioids | Prolong; depression; protein binding |
| High anion gap metabolic acidosis occurs when there is an increase in _____ acids; the acids dissociate into ___ ions, which consume HCO3 to produce ____ and the anions take the place of HCO3 in ECF | Non-volatile; H+; CO2 (seen with diabetic ketoacidosis) |
| Changes in ____ affect pO2, pCO2, & pH. Therefore, both pCO2 and pO2 ____ during hypothermia while the pH ____ | Temperature; decrease; increases |
Created by:
SRNADani