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acid base lecture

acid base lecture notes

Acid - donates a proton; releases H+ H+ + Cl- = Hydrochloric acid Too much H+ Acidemia - blood Acidosis-overall condition in body fluids When acid meets base…they neutralize! When acid meets base…they neutralize!
Base accepts or combines with a proton Na++ OH- = Sodium Hydroxide Too much base Alkalemia - blood Alkalosis- overall condition in body fluids
Clinical Manifestations of alkalosis Death convulsions arrhythmia irritability
Clinical Manifestations of acidosis drowsiness lethargy coma
Blood Buffers Acids are carried by Hb and HCO3 (88%) Bicarb system is open, primary system Due to loss of CO2 through breathing HC03 + H+ = H20 + CO2 (exhaled) Nonbicarb systems are closed Nothing is “lost” Hemoglobin, phosphates, proteins
Henderson-Hasselbach Equation Allows you to calculate pH, CO2, or HCO3 if you know 2 of the 3 variables in the formula Use: to check if pH, PCO2, and HCO3 in an ABG report are compatible, and to predict what happens when you change one component in the ABG
CO2 excretion depends on: Perfusion Diffusion Ventilation Think heart, lungs or CNS
Respiratory Acidosis Clinical signs hypoxemic manifestations, warm flushed skin, bounding pulse, arrhythmias, > ICP, headaches, <Cl-
Respiratory Acidosis Causes acute airway obstruction massive PE drugs (sedatives, narcotics) neuromuscular disease trauma (brain, spinal cord, chest wall) obesity kyphoscoliosis COPD cardiac arrest
Respiratory Alkalosis Terms: excess CO2 elimination, hypocapnia, hyperventilation Compensation: kidneys excrete HCO3 acute: -PaCO2 by 5 = HCO3 - by 1 (24-48 hrs) chronic: -PaCO2 by 10 = HCO3 - by 5
Respiratory Alkalosis Clinical signs tachypnea, dizziness, light-headedness, sweating, paresthesia
Respiratory Alkalosis Causes hypoxemia anxiety fever stimulant drugs pain brain tumor sepsis exercise early onset asthma pneumonia, pulmonary edema, CHF iatrogenic (vent, IPPB
Metabolic Acidosis Clinical signs hyperpnea, Kussmaul’s resp.in severe diabetic ketoacidosis, dyspnea, headache, N/V, lethargy, coma (severe)
Anion Gap Helps indicate the cause of metabolic acidosis Anion gap = Na+ - (Cl- + HCO3) Normal: 9 to 14 mEq/L Increased (>14) = metabolic acidosis is caused by an increase in fixed acids Normal anion gap = metabolic acidosis is caused by loss of HCO3
Anion Gap Metabolic Acidosis Due to increased fixed acids Causes: Diabetic ketoacidosis Lactic acidosis Alcoholic ketoacidosis Advanced renal failure Ethylene glycol intoxication Methanol intoxication (formic acid) Salicylate intoxication (aspirin)
Metabolic Alkalosis Usually accompanied by hypokalemia -Common in ICU; difficult to treat Compensation: hypoventilation but usually uncompensated : lower RR, apnea, cyanosis, N/V, confusion, headache, lethargy, tetany in severe cases
Metabolic Alkalosis Causes NG suction Diuretics Vomiting Steroids Hypokalemia Hypochloremia Hypovolemia NaHCO3 infusion Excessive antacids or alkali for peptic ulcers Posthypercapnic met. alkalosis Massive blood transfusion (>8 units)
Created by: meyoufools