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EXAM 2 - MED SURG II

ABGs

QuestionAnswer
Metabolic Acidosis Base Bicarbonate Deficit. It is a common clinical disturbance characterized by a low pH due to increased H+ concentration and a low plasma bicarbonate concentration. Can occur by a gain of hydrogen ions or a loss of bicarbonate ions in the blood.
Normal Anion Gap Metabolic Acidosis Results from the direct loss of bicarbonate, as in diarrhea, lower intestinal fistulas, ureterostomies, use of diuretics, early renal insufficiency, excessive administration of chloride, and administration of parenteral nutrition without bicarbonate or bicarbonate products
High Anion Gap Metabolic Acidosis Occurs when there is an excessive accumulation of acids. Occurs in lactic acidosis, salicylate poisoning (acetylsalicylic acid), renal failure, methanol, ethylene, or propylene glycol toxicity, DKA, and ketoacidosis that occurs with starvation
Clinical Manifestations of Metabolic Acidosis Headache, confusion, drowsiness, increased RR and depth, nausea, and vomiting. Peripheral vasodilation and decreased cardiac output, decreased BP, cold, clammy skin, arrhythmias, and shock.
Assessment & Diagnostic Findings in Metabolic Acidosis Bicarbonate level of less than 22 mEq/L and low pH of less than 7.35. Abnormal K+ serum. ECG can show arrhythmias (especially with changes of potassium in the blood)
Medical Management of Metabolic Acidosis Aims at correcting the imbalance. If caused by excessive chloride (eliminate the source of chloride). When necessary bicarbonate is given - however the administration of sodium bicarbonate during cardiac arrest, can result in paradoxical intracellular acidosis. Hyperkalemia may occur with acidosis, and hypokalemia with reversal of acid
Metabolic Alkalosis Blood pH is greater than 7.45, and the HCO3 - is greater than 26 mmol/L
Causes of Metabolic Alkalosis Gastric losses, as in vomiting or excessive gastric aspiration
Clinical Manifestations of Metabolic Alkalosis H+ and Ca++ ions decrease in the bloodstream, and hypocalcemia develops. Tingling of fingers and toes, dizziness, and tetany (cramping of muscles). In hypokalemia, prominent U waves develop on ECG and ventricular rhythm disturbances such as PVCs. Can also lead to decreased GI motility and paralytic ileus
Plasma pH An indicator of hydrogen ion (H+) concentration, and measures the acidity or alkalinity of the blood.
The H+ Concentration The greater the concentration, the more acidic the blood is, and the lower the ph. The lower the concentration, the more alkaline the solution is and the higher the pH
Medical Management of Metabolic Alkalosis Normal saline, monitoring I&Os. KCl for hypokalemia and hypocalcemia. PPIs to reduce production of gastric hydrogen chloride. Carbonic Anhydrase Inhibitors (acetazolamide) useful in those that cannot tolerate rapid volume expansion (HF)
Respiratory Acidosis Blood pH is less than 7.35 and PaCO2 is great than 45
Causes of Respiratory Acidosis Airway obstruction, as with inhalation of a foreign body, impaired alveolar filling as in bronchopneumonia, depression of respiratory center, as with drug overdose, or semiconscious patients
Clinical Manifestations of Respiratory Acidosis Sudden hypercapnia. Increased pulse, BP, and RR. Confusion, disorientation, or diminished LOC. In severe cases intracranial pressure may increase, resulting in papilledema and dilated conjunctival blood vessels. Can cause hyperkalemia. Often asymptomatic in COPD patients
Medical Management of Respiratory Acidosis Improving ventilation, bronchodilators, antibiotics for infection, thrombolytics or anticoagulants, pulmonary physiotherapy and nebulizers, adequate hydration. Oxygen and mechanical ventilation if needed.
Respiratory Alkalosis Blood pH is greater than 7.45 and the PaCO2 is less than 35
Causes of Respiratory Alkalosis A fall in oxygen levels, as in severe anemia, pulmonary disease, or high altitude. Stimulation of the CNS as in aspirin overdose or raise intracranial pressure.
Clinical Manifestations of Respiratory Alkalosis Lightheadedness, inability to concentrate due to cerebral artery vasoconstriction and decreased cerebral blood flow, numbness and tingling from decreased calcium ionization in the blood, tinnitus, and sometimes loss of consciousness. Cardiac effects include tachycardia and ventricular and atrial arrhythmias.
Management of Respiratory Alkalosis Aimed at underlying cause. If there is anxiety, encourage slow breathing, to allow CO2 to accumulate or to breathe into a closed system (paper bag or CO2 rebreather mask). Antianxiety agent may be required.
pH Measured acid-base balance of the blood
PaO2 Measured partial pressure of oxygen in arterial blood
PaCO2 Measured partial pressure of carbon dioxide in arterial blood
HCO3 Calculated concentration of bicarbonate in arterial blood
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