metabolic acidosis- bicarb deficit- ch 14 p293-298
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| Normal pH values | Arterial pH = 7.35-7.45
Mixed Venous = 7.32-7.42
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| Normal PaCO2 values | Arterial PaCO2 = 35-45 mmHg
Mixed Venous = 38-52 mmHg
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| Normal PaO2 values | Arterial PaO2 = 70-100 mmHg
Mixed Venous = 24-48 mmHg
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| Normal HCO3- Value | Arterial HCO3- = 19-25 mEq/L
Mixed Venous HCO3- = 19-25 mEq/L
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| Normal values Oxygen saturation arterial / venous | Arterial O2 sat = >90-95%
Venous O2 sat = 40-70%
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| Average ABG values pH PaCO2 HCO3- | Average ABG values
pH = 7.4
PaCO2 = 40mmHg
HCO3- = 24 mEq/L
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| serum pH 7.4 = >7.4 = <7.4 = | serum pH
7.4 = normal
>7.4 = alkalosis
<7.4 = acidosis
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| Plasma pH is an indicator of? | Plasma pH is an indicator of
hydrogen (H+) ion concentration
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| Homeostatic mechanisms that maintain pH... | -Buffer systems
-Kidney
-Lungs
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| The greater H+ concentration the solution is more _______ with _____ pH | The greater the H+ concentration the solution is more ACIDIC with LOWER pH (<7.4)
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| The lower the H+ concentration the solution is more ____ with _____ pH | The lower the H+ concentration the solution is more ALKALINE with HIGHER pH (>7.4)
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| Buffer systems prevent major changes in the pH of body fluids by... | Buffer systems prevent major changes in the pH of body fluids by...
REMOVING OR RELEASING H+ ions.
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| Major Extracellular buffer system is the.. | Major Extracellular buffer system is the..BICARBONATE-CARBONIC ACID BUFFER SYSTEM
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| ABG's measure/assess which pH buffer system? | ABG's measure/assess BICARBONATE-CARBONIC ACID BUFFER SYSTEM
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| Normal ratio of Bicarbonate (HCO3-) Carbonic Acid (H2CO3) | Normal ratio of
Bicarbonate (HCO3-)= 20
Carbonic Acid (H2CO3)= 1
20(HCO3-):1 (H2CO3)
THE RATIO MAINTAINS pH / not absolute values
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| When CO2 is dissolved in water it becomes... | When CO2 is dissolved in water it becomes...CARBONIC ACID (H2CO3)
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| Which organ regulates the bicarbonate level in the ECF? | The KIDNEYS regulates the bicarbonate level in the ECF?
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| In most ACIDOSIS (<7.4) the kidneys ___ H+ and conserve ___ to help restore pH balance. | In most ACIDOSIS the kidneys EXCRETE H+ and conserve BICARBONATE (HCO3-) to help restore pH balance.
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| In most ALKALOSIS (>7.4) the kidneys ___ H+ and conserve ___ to help restore pH balance. | In most ALKALOSIS the kidneys RETAIN H+ and excrete BICARBONATE (HCO3-) to help restore pH balance.
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| ECF Carbonic Acid (H2CO3)regulation is controlled by the ... | ECF Carbonic Acid (H2CO3) regulation is controlled by the ...LUNGS (controlled by the medulla)
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| How/Why do the lungs control the carbonic acid (H2CO3)level? | The lungs control carbonic acid (H2CO3) by adjusting ventilation in response to the serum CO2 level
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| A rise in PaCO2 (partial pressure CO2)is powerful stimulation of... | A rise in PaCO2 (partial pressure CO2)is powerful stimulation of... RESPIRATION
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| In metabolic ACIDOSIS (<7.4), the respiratory rate ___, causing ___ of ___. | In metabolic ACIDOSIS, the respiratory rate INCREASES causing ELIMINATON of CO2.
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| In metabolic ALKALOSIS (>7.4), the respiratory rate ___ causing ___ of ___. | In metabolic ALKALOSIS, the respiratory rate DECREASES causing RETENTION of CO2.
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| low pH = increased ___ and low plasma ___ concentration. | LOW pH = increased H+ and LOW plasma Bicarbonate(HCO3-)concentration.
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| Anion Gap is essential in analyzing ___ correctly | Anion Gap is essential in analyzing ACID-BASE DISORDERS correctly
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| list the 3 normally unmearsured ECF anions... | Phosphates
Sulfates
Proteins
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| ___ is often omitted from the anion gap equation because of its low plasma level. | POTASSIUM is often omitted from the anion gap equation because of its low plasma level.
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| Anion gap equations | Anion Gap = Na + K - (Cl + HCO3)
anion gap = sodium + potassium (chloride + bicarb)
OR
Anion Gap = Na - (Cl + HCO3)
ag = sodium - (chloride + bicarb)
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| Normal anion gap (w/o potassium) VS. Normal anion gap (with potassium) | Normal anion gap (w/o potassium)
8-12 mEq/L / 8-12 mmol/L
VS.
Normal anion gap (with potassium)
12-16 mEq/L / 12-16 mmol/L
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| Normal anion gap ACIDOSIS is also called... | Normal anion gap ACIDOSIS
is also called...
HYPERCHLOREMIC ACIDOSIS
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| Disorders that cause negative/decreased anion gap are... | Disorders that cause negative/decreased anion gap are...RARE
(compared to increased/high anion gap)
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| HYPERCHLOREMIC ACIDOSIS/Normal anion gap ACIDOSIS results from a direct loss of ___? | HYPERCHLOREMIC ACIDOSIS/Normal anion gap ACIDOSIS results from a direct loss of BICARBONATE (HCO3-)
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| HYPERCHLOREMIC ACIDOSIS/Normal anion gap ACIDOSIS may result from what conditions? | HYPERCHLOREMIC ACIDOSIS/Normal anion gap ACIDOSIS may result from: Diarrhea, lower intestinal fistulas, ureterostomies, diuretic use, early renal insufficiency, excess chloride admin, TPN admin w/o bicarb.
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| Reduced or Negative anion gap is rare but primarily produced by... | Reduced or Negative anion gap is rare but primarily produced by...HYPOPROTEINEMIA
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| S/S OF metabolic acidosis (<7.35): | -headache
-confusion
-drowsiness
-increased resp & depth
-nausea / vomiting
*Decreased BP, cold clammy skin, dysrthmias, SHOCK.
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| What occurs when the serum pH <7 ? | Vasodilation & Decreased Cardiac Output
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| ****************** The cardinal feature of METABOLIC ACIDOSIS is ... ****************** | The cardinal feature of metabolic acidosis is ...
DECREASED SERUM BICARB
(ABG: HCO3- = <22mEq/L)
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| metabolic acidosis root cause = | metabolic acidosis root cause =
base bicarbonate (HCO3-) deficit
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| What electrolyte imbalance may coincide with metabolic acidosis? | HyperKalemia may accompany metabolic acidosis, resulting from K+ shifting out of cells into the ECF
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| Treatment of metabolic acidosis is.. | -correct cause..i.e.>chloride admin
-monitor ECG, ABG, pulse ox
-MONITOR SERUM K+ for hypokalemia
-hypOKalemia corrected as acidosis reversed
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| In chronic metabolic acidosis, low serum ____ levels are treated before acidosis to avoid ____. | In CHRONIC metabolic acidosis,
low serum CALCIUM levels are treated before acidosis to avoid TETANY.
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| METABOLIC ACIDOSIS(Ph<7.35) INITIAL EVENT: ↓ ph ↓ HCO3- ↓or normal PaCO2 COMPENSATION = ? | METABOLIC ACIDOSIS(Ph<7.35)
COMPENSATION =
HypERVentilation = ↓PaCO
(conserves HCO3-)
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