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Patho Acid Base

Reasoning through acid base imbalances -- from Copstead, Banasik Pathophysiology

QuestionAnswer
normal pH for adults 7.35 - 7.45
acidosis high values - low pH
alkalosis low values - high pH
compensation normalizing pH; makes other values abnormal. opposite system, same direction
correction normalizing pH; fixes the problem. same system as problem, same direction
blood gases blood parameters: pH, PO2, PaCO2, bicarbonate
Where is carbonic acid produced in the body? Where is it excreted? Produced in cells; excreted through lungs
Where are metabolic acids produced in the body? Where are they excreted? Produced in cells; excreted by kidneys
why is too much acid in the body a problem? cell enzymes work best at a certain pH
bicarbonate: carbonic acid (normal pH) 20:1
PaCO2 partial pressure of carbon dioxide
HCO3- bicarbonate
H+ hydrogen ion: concentration of it determines pH
CO2 carbon dioxide
H2CO3 carbonic acid
Buffers – types bicarbonate; phosphate;hemoglobin; protein
Buffers – function prevent large changes in pH
If a fluid has too much H+, how does the buffer system return pH to normal? How does the buffer system restore its normal proportions? base portion takes on H+ and becomes an acid; excretes excess acid
If a fluid has too little H+, how does the buffer system return pH to normal? How does the buffer system restore its normal proportions? acid portion releases an H+ and becomes a base; retains more acid
Bicarbonate buffer HCO3- (base) / H2CO3 (weak acid); found in ECF -- vascular and interstitial
Phosphate buffer intracellular and renal tubular fluid and urine
Hemoglobin buffer inside RBCs
Protein buffer intracellular and vascular
What acid is excreted through respiration? Relationship betw change in respiration and excretion of acid? carbonic acid as CO2 and H2O; rate and depth increases to excrete, decreases to retain
What is the role of chemoreceptors in excretion of carbonic acid? change rate and depth of resp with change in PaCO2, pH
What is the difference between correction and compensation with regard to acid-base imbalances? correction returns all blood values to normal; compensation returns pH to normal but causes imbalances in other blood values
In what situation is hyperventilation a compensatory response? In what situation is it a corrective response? compensatory: metabolic acidosis; corrective: respiratory acidosis
What type of acid do the kidneys excrete? Which acid are they unable to excrete? metabolic acids; not carbonic acid
How does renal excretion of acid increase the blood bicarbonate ion concentration? As H+ is excreted into renal tubular fluid, bicarbonate is obliged to travel opposingly into blood
How does renal tubular cell production of ammonia assist the excretion of hydrogen ions? ammonia (NH3-) combines with H+ to make NH4, which can't go back through to blood and must be excreted
How do the kidneys compensate for an excess of carbonic acid? excrete more metabolic acids, so net pH returns to normal
How do the kidneys respond to increased blood pH? Secrete less H+ and ammonia into renal tubules; make urine more alkaline
How would the kidneys respond to a large excess of thyroid hormones (untreated hyperthyroidism)? Secrete more H+ and ammonia into renal tubules; make urine more acidic
How do the kidneys respond to prolonged increase of carbonic acid in the blood? Secrete more H+ and ammonia into renal tubules; make urine more acidic
What is the difference between acidosis and acidemia? Between alkalosis and alkalemia? acid and alkalosis is presence of factors that tend to lower/raise blood pH; -emia refers to the lowered/raised state of pH of the blood
What is metabolic acidosis, and what two general mechanisms cause it? condition tending toward too much acid in blood, due to acids normally excreted by kidneys. increase of metabolic acid, decrease of base
Why is decreased PaCO2 a sign of metabolic acidosis? Compensatory mechanism in metabolic acidosis
Why are confusion, lethargy, stupor symptoms of metabolic acidosis? decreased intracellular pH in neurons
Why are cardiac dysrhythmias symptoms of metabolic acidosis? decreased intracellular pH in myocardial cells
Why is decreased blood bicarbonate a sign of metabolic acidosis? buffering excess acid
Why is low blood pH a sign of metabolic acidosis? relative increase of metabloic acids in blood
Why is abdominal pain a possible symptom of metabolic acidosis? not well understood
What is respiratory acidosis, and what three general mechanisms cause it? Impaired gas exchange, impaired neuromuscular function (chest wall), impaired respiratory control (brainstem)
What conditions may cause impaired gas exchange? COPD, pneumonia, severe asthma, pulmonary edema, acute (adult) respiratory distress syndrome, obstructive sleep apnea
What conditions may cause impaired neuromuscular function? Guillain- Barre syndrome, Chest injury or surgery (pain), hypokalemic respiratory muscle weakness, kyphoscoliosis, respiratory muscle fatigue
What conditions may cause impaired respiratory control? Respiratory depressant drugs (opiates, barbiturates), central sleep apnea
Why is low blood pH a sign of respiratory acidosis? increased carbonic acid in blood
Why is increased blood bicarbonate a sign of respiratory acidosis? compensatory response by kidneys
Why is headache a symptom of respiratory acidosis? cerebral vasodilation
Why are tachycardia and cardiac dysrhythmias symptoms of respiratory acidosis? decreased intracellular pH in myocardial cells
Why are disorientation and lethargy symptoms of respiratory acidosis? decreased intracellular pH in neurons
What is metabolic alkalosis, and what two general mechanisms cause it? condition that tends to cause relative deficit of metabolic acids (any other than carbonic acid). Caused by increase of base, or decrease of metabolic acid
Why is increased blood bicarbonate a sign of metabolic alkalosis? increased intake or unused buffers
Why are slow, shallow respirations a sign of metabolic alkalosis? compensatory response by lungs
Why are paresthesias, muscle twitching and cramping symptoms of metabolic alkalosis? increased neuromuscular excitability
Why is high blood pH a sign of metabolic alkalosis? relative deficit of metabolic acids
How is hypokalemia related to metabolic alkalosis? cause metabolic alkalosis or be caused by it
Why are beligerence or confusion, lethargy, seizures, coma symptoms of metabolic alkalosis? neuron dysfunction from increased intracellular pH and increased neural excitability
What is respiratory alkalosis, and what general mechanism causes it? condition tending to cause deficit of carbonic acid in blood; hyperventilation
What conditions may cause hyperventilation? hypoxemia, pain, anxiety/distress, prolonged sobbing, alcohol withdrawal, stimulation of brainstem
How might the brainstem become stimulated and result in hyperventilation? salicylate overdose, meningitis, head injury, gram-neg sepsis
Why is high blood pH a sign of respiratory alkalosis? Decreased carbonic acid in blood
Why is decreased blood bicarbonate a sign of respiratory alkalosis? Compensation by kidneys
Why are rapid, deep respirations a sign of respiratory alkalosis? This is hyperventilation, the cause of respiratory alkalosis
Why are paresthesias, muscle twitching, and cramping symptoms of respiratory alkalosis? Less ionized calcium available (dec cell activity) leads to increased neuromuscular excitability
Why is confusion a symptom of respiratory alkalosis? increased intracellular pH in neurons and decreased cerebral blood flow
What are mixed acid-base imbalances? How do they affect pH of the blood? More than one primary imbalance in the same person. If both acidosis or both alkalosis, pH increased or decreased more significantly. If there is a mix of acidosis and alkalosis, pH near normal depending on severity of each.
What acid-base imbalance can result from hypoxemia? Why? respiratory alkalosis; causes rapid, deep breathing (hyperventilation)
What acid-base imbalance can result from pain? Why? respiratory alkalosis; can cause increase in rate and depth of breathing
What acid-base imbalance can result from anxiety or psych distress? Why? respiratory alkalosis; causes increase in rate and depth of breathing
What acid-base imbalance can result from prolonged sobbing? Why? respiratory alkalosis; gasping in between sobs causes deep, fast breathing
What acid-base imbalance can result from alcohol withdrawal? Why? respiratory alkalosis; absence of depressant effect leaves resp center sensitive to CO2, causing hyperventilation
What acid-base imbalance can result from stimulation of the brainstem? Why? respiratory alkalosis; stimulation of respiratory center results in increase of rate and depth of breathing
What acid-base imbalance can result from COPD? Why? respiratory acidosis; Impaired gas exchange
What acid-base imbalance can result from Pneumonia? Why? respiratory acidosis; esp bacterial; exudate builds up in alveoli, leading to Impaired gas exchange
What acid-base imbalance can result from severe asthma? Why? respiratory acidosis; constriction of bronchioles causes difficulty breathing: Impaired gas exchange
What acid-base imbalance can result from pulmonary edema? Why? respiratory acidosis; fluid in alveoli? Causes impaired gas exchange
What acid-base imbalance can result from acute respiratory distress syndrome? Why? respiratory acidosis; Impaired gas exchange
What acid-base imbalance can result from obstructive sleep apnea? Why? respiratory acidosis; Impaired gas exchange
What acid-base imbalance can result from guillain-Barre syndrome? Why? respiratory acidosis; impaired neuromuscular function
What acid-base imbalance can result from chest injury or surgery? Why? respiratory acidosis; impaired neuromuscular function
What acid-base imbalance can result from hypokalemia? Why? respiratory acidosis; impaired neuromuscular function due to respiratory muscle weakness
What acid-base imbalance can result from kyphoscoliosis? Why? respiratory acidosis; impaired neuromuscular function
What acid-base imbalance can result from respiratory muscle fatigue? Why? respiratory acidosis; impaired neuromuscular function
What acid-base imbalance can result from opiates or barbiturates? Why? respiratory acidosis; impaired respiratory control caused by respiratory depressant drugs
What acid-base imbalance can result from central sleep apnea? Why? respiratory acidosis; impaired respiratory control
What acid-base imbalance can result from ketoacidosis? Why? metabolic acidosis; increase in acid due to rapid production of unusual acids that overwhelm renal excretory capability; from diabetes m., starvation, alcoholism
What acid-base imbalance can result from severe hyperthyroidism? Why? metabolic acidosis; increase in acid due to increased cellular metabolism
What acid-base imbalance can result from severe infection? Why? metabolic acidosis; increase in acid due to increased cellular metabolism
What acid-base imbalance can result from burns? Why? metabolic acidosis; increase in acid due to increased cellular metabolism
What acid-base imbalance can result from circulatory shock? Why? metabolic acidosis; increase in acid due to decreased renal acid excretion
What acid-base imbalance can result from tissue anoxia? Why? metabolic acidosis; increase in acid due to rapid production of lactic acidosis, overwhelms excretory capability
What acid-base imbalance can result from oliguric renal failure? Why? metabolic acidosis; increase in acid due to decreased renal excretion
What acid-base imbalance can result from intake of acids, precursors? Why? metabolic acidosis; increase in acid; precursors include salicylates, methanol, boric acid, ethylene glycol
What acid-base imbalance can result from diarrhea? Why? metabolic acidosis; increased excretion of bicarb (normal route)
What acid-base imbalance can result from gastrointestinal fistula that drains intestinal or pancreatic secretions? Why? metabolic acidosis; loss of bicarb (abnormal route)
What acid-base imbalance can result from intestinal decompression (suction)? Why? metabolic acidosis; loss of bicarb (abnormal route)
What acid-base imbalance can result from renal tubular acidosis? Why? metabolic acidosis; increased excretion of bicarb (normal route)
What acid-base imbalance can result from profound ECF volume deficit? Why? metabolic acidosis; inability to excrete acids
What acid-base imbalance can result from intake of bicarb or precursors? Why? metabolic alkalosis; increase in base due to intake; body turns acetate, citrate, lactate into bicarb
What acid-base imbalance can result from massive transfusion of citrated blood? Why? metabolic alkalosis; increase in citrate which body turns to bicarb
What acid-base imbalance can result from mild/moderate ECF volume deficit? Why? metabolic alkalosis (contraction alkalosis); increase in base due to increased renal reabsorption of bicarbonate. Also decrease in acid because of increased excretion
What acid-base imbalance can result from emesis? Why? metabolic alkalosis; decrease in acid due to loss (abnormal route)
What acid-base imbalance can result from gastric suction? Why? metabolic alkalosis; decrease in acid due to loss (abnormal route)
What acid-base imbalance can result from hyperaldosteronism? Why? metabolic alkalosis; decrease in acid due to increased renal excretion of metabolic acids
What acid-base imbalance can result from hypokalemia? Why? metabolic alkalosis; decrease in acid due to potassium ion shift into cells
Created by: hezasan