PHRM 864: Therapeutics IV > Acid/Base > Flashcards

Acid/Base Flashcards

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1
Q

What is the normal range for pH?

A
  • 7.35-7.45 [<6.7 or >7.7 is BAD for life]
  • <7.35 is acidosis & >7.45 is alkalosis
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2
Q

How do we know when an acid-base disorder affects a certain organ?

A
  • Metabolic = Kidney [Lungs compensate]
  • Respiratory = Lungs [Kidneys compensate]
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3
Q

What are the normal blood gas levels [arterial blood]?

A
  • PaCO2 = 35-45 mmHg [“40”]
  • HCO3 = 22-26 mEq/L [“24”]
  • PaO2 = 95-100 mmHg
  • SaO2 = >95%
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4
Q

What are some of the adverse consequences for Acidemia?

A
  • Cardiovascular
  • Metabolic
  • CNS
  • Other
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5
Q

What are some of the Cardiovascular Adverse Events for Acidemia?

A
  • DECREASE Cardiac Output [heart isnt pumping]
  • Impaired contractility
  • INCREASE vascular resistance
  • Arrhythmia [Related toward metabolic]
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6
Q

What are some of the Metabolic Adverse Events for Acidemia?

A
  • Insulin Resistance
  • INHIBTION of anaerobic glycolysis
  • HYPERkalemia [cardio]
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7
Q

What are some of the CNS Adverse Events for Acidemia?

A
  • Coma
  • Altered mental status
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8
Q

What are some of the Other Adverse Events for Acidemia?

A
  • Decreased respiratory muscle strength
  • HYPERVENTATION
  • SOB
  • N/V
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9
Q

What are some adverse consequences for Alkalosis?

A
  • Cardiovascular
  • Metabolic
  • CNS
  • Other
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10
Q

What are some of the cardiovascular adverse events for Alkalosis?

A
  • DECREASE blood flow
  • Decreased anginal thershold
  • Arrhythmia [related toward metabolic]
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11
Q

What are some of the Metabolic adverse events for alkalosis?

A
  • DECREASE K, Ca, Mg
  • Stimulation of Anaerobic glycolysis
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12
Q

What are some of the CNS adverse events for alkalosis?

A
  • Lethargy, Delirium, Stupor, Seizures
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13
Q

What are some of the Other adverse events for Alkalosis?

A
  • DECRASED respirations
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14
Q

What are the three [four-ish] standards mechanisms for acid-base regulation?

A
  • Buffering
  • Renal Regulation
  • Ventilatory Regulation
  • [Hepatic Regulation]
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15
Q

What is important to know about the buffering mechanisms?

A
  • FIRST LINE defense
  • Buffers: Bicarb, Phosphate, Proteins
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16
Q

What is important to know about Bicarb in the buffering mechanism?

A
  • RAPID ONSET with intermediate capacity
  • HCO3 has the largest conc. [CO2 is unlimited]
  • Controlled by HCO3 & CO2 [kidneys & lungs]
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17
Q

What happens when there is acid added?

What does this mean?

A
  • Large quantities of CO2 gets exhaled rapidly
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18
Q

What is important to know about Phosphate in the buffering mechanism?

A
  • INTERMEDIATE ONSET and capacity
  • Limited activity
  • Ca/P in is the bone [must be broken down to get = bad to do]
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19
Q

What are the ways that the renal system regulation?

A
  • Bicarb Reabsorption [reabsorb]
  • Ammonium Excretion & Titratable Acidity [new]
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20
Q

Briefly describe what happens in the Bicarb Reabsorption pathway?

A
  • HCO3 [lumen] combines with H [cell] making H2CO3
  • H2CO3 splits into CO2 & H2O
  • CO2 & H2O reabsorbs into cell to make H2CO3
  • H2CO3 makes HCO3, absorbing to blood stream
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21
Q

Where does the Bicarb Reabsorption Pathway take place?

A
  • Proximal Tubule [85-90%]
  • Filters 4000-4500 mEq
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22
Q

What is important to know about the Carbonic Anhydrase Inhibitors in the Bicarb Reabsorption Pathway?

A
  • It blocks the inhibition of H2CO3 breakdown; decreasing HCO3
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23
Q

Briefly describe what happens in the Bicarb generation pathway [ammonium & titrable]?

A
  • Ammonium: H combines NH3 = NH4; HCO3 [cell] reabsorbs into the blood stream [300 mEq/d]
  • Titratable: H combines HPO4 = H2PO4; HCO3 [cell] reabsorbs into the blood stream [40 mEq/d]
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24
Q

Where does the Bicarb Generation Pathway take place?

A
  • Distal Tubule
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25
What is important to know about the Ventilatory Regulation ?
- RAPID ONSET and LARGE CAPACITY - Chemoreceptors detect increase in PaCO2 = increased respirations [blowing off CO2]
26
What is important to know about the Hepatic Regulation?
- **NEW** maybe in times of acidosis the liver shutdown urea; pushing it towards alkalosis
27
What is teh compensation charateristics for acid-base disorders?
- Mac: D HCO3 = D PaCO2 [increased breathing] - Malk: I HCO3 = I PaCO2 [decreased breathing] - Rac: I PaCO2 = I HCO3 [Kidneys compensate] - Ralk: D PaCO2 = D HCO3 [Kidneys compensate]
28
What are the acid-base disorders?-
- Metabolic Acidosis - Metabolic Alkalosis - Respiratory Acidosis - Respiratory Alkalosis
29
What are the characteristics of Metabolic Acidosis?
- Low pH: < 7.35 - Low HCO3: <24 - Decreased PaCO3 [ventilation]
30
What are the two types of Metabolic Acidosis?
- Non-Anion Gap - Anion Gap
31
What is the pathosiology of non-anion gap acidosis?
- GI Bicarb Loss - Renal Bicarb Loss - Reduced Renal H Excretion
32
What is important about GI Bicarb Loss in non-anion gap acidosis? | Side Effects?
- Diarrhea: very common cause [lose 5-10 L of fluids (1 L has 30-50 mEq of HCO3)] - Fistulas - rich in bicarb [might lose HCO3]
33
What is important about Renal Bicarb Loss in Non-anion gap acidosis?
- Type II Renal Tubular Acidosis [Proximal] - Reabsorption of HCO3 in reduced in Proximal causing a loss in Na & Fluids = hypokalemia
34
**What is important about Reduced Renal H Excretion in non-anion gap acidosis?**
- Type I RTA [Hypokalemia]: H cannot go into lumen = increase K excretion - Type IV RTA [Hyperkalemia]: Decreased aldsterone = H retention; holding on to K= acidosis -
35
What is the Pathophysiology of Anion Gap acidosis [MULEPAK]?
- **M**: Methanol Intoxication - **U**: Uremia - **L**: Lactic Acidosis - **E**: Ethylene Glycol - **P**: Paraldehyde Ingestion - **A**: Aspirin - **K**: Ketoacidosis
36
After finding out the anion gap, what is the next thing that you should do?
- Calculate the Delta Gap - DG = patients anion gap [Na - (Cl + HCO3)] - Normal Anion Gap - Delta Gap makes elevated HCO3 = Acidosis + Alkalosis
37
What are the causes fo anion gap metabolic acidosis?
- Lactic Acidosis [Most Common] - Ketoacidosis - Drug Interactions
38
What is the importance of lactic acidosis in anion gap metabolic acidosis?
-**most common for Anion** - Lactate is normally aroind 1meq/l but in Lactic Acidosis it ~5mEq/l
39
What are the possible causes for Lactic Acidosis?
- Shock [making more of it] - Drugs: [Ethanol, Warfarin, NRTIs (HIV meds), Propofol, Propylene Glycol] - Seizures: makes a lot - Leukemia - Hepatic/Renal Failure - Diabetes
40
What is more likely to cause Drug Intoxication in anion gap metabolic acidosis?
- Salicylates: increase respiration & increase acid [Respiratory Alkalosis & Metabolic Acidosis] - Methanol - Ethylene glycol
41
What are the symptoms of Lactic Acidosis?
- Kussmaul respiration [deep & rapid] - Tachycardia - HYPERkalemia - Lethargy/coma - N/V
42
What is the treatment for Lactic Acidosis?
- Treat underlying cause FIRST - Acute Bicarb Therapy [<7.10-7.15; Hyperkalemia; use 12 mEq/L --> give 1/3 to 1/2; supplement K]
43
What are some of the hazard of Bicarb therapy?
- Overalkanization: reduce cerebral flow - Hypernatremia - Eletrolyte shifts [Potassium: acidosis K moves out; added bicarb will move MORE K out & Calcium: cardio issues]
44
What are the characteristics of Metabolic Alkalosis?
- High pH: > 7.45 - High HCO3 - Increased PaCO2 [shallow breathing]
45
What is the pathophysiology of Metabolic Alkalosis?
- Rise in HCO3 b/c of loss of acid in the GI - Give too much Bicarb - Losing Cl-
46
What are the two type of Metabolic Alkalosis?
- Saline Responsive Alkalosis [ - Saline Resistant Alkalosis [
47
What are the causes of Saline Responsive Metabolic Alkalosis?
- DIURETIC THERAPY [MOST COMMON] - Vomiting & NG Suction - Blood Transfusions
48
What is important to know about Diuretic Therapy in Saline Responsive Metabolic Alkalosis?
- **MOST COMMON** - Furosemide, Toresemide, Bumetanide, HCTZ - The excretion of NaCl stimulates aldosterone; increasing Na reabsorption and H & K secretion; H secretion = HCO3 reabsorption
49
What is important to know about Vomiting & NG suction in Saline Responsive Metabolic Alkalosis?
- **2nd MOST COMMON** - 1L/d is lost from vomiting = 200mEq of Cl [losing Cl = Increased HCO3] & 25-100mEq H
50
What is important to know about Blood transfusion in Saline Responsive Metabolic Alkalosis?
- Involves Lactated Ringers, HCO3, TPN... - Citrate breaks down into HCO3
51
What are the causes of Saline Resistant Metabolic Alkalosis?
- NO drop in Cl - Increased Mineralocorticoid Activity [H secretion = increased HCO3] - HYPOkalemia [H secretion = increased HCO3] - Renal Tubular Cl Wasting [increased aldosterone = same as the diuretics]
52
What are some of the symptoms for Saline Resistant Metabolic Alkalosis?
- Muscle Cramps, Weakness [decreased K] - Mental Confusion, Coma, Seizures - Arrhythmias
53
What is the treatment for Saline Responsive Metabolic Alkalosis?
- **Give fluids** [Na & Cl reabsorbed; increase K = decreased H; caution in HF] - **Carbonic Anhydrase Inhibitors** [Decreased HCO3 reabsorption; not good in severe alkalosis] - **HCl Acid** [for those with NA replacement or failure of therapies] - **Ammonium Cl** - **Arginine Monohydrocholride** [last line]
54
What is the treatment options for Saline Resistant Metabolic Alkalosis?
- CORRECT decreasing K - Decrease mineralocorticoid dose - Give spironolactone
55
What are the two Respiratory Disorders in Acid Base?
- Respiratory Acidosis - Respiratory Alkalosis
56
What is the characteristics of Respiratory Acidosis?
- Low pH: <7.35 - Increased PaCO2 - Increased HCO3
57
What is the pathophysiology of Respiratory Acidosis?
- "something blocking the airway; CO2 cant escape" - Airway Obstruction [Asthma, Foreign Body, Aspiration] - Reduced stimulus of Respiration [OD, Apena, Trama] - Heart or Lung Failure - CNS issues - Mechanical Vent
58
What are the symptoms of Respiratory Acidosis?
- Respiratory: SOB - CNS: HA, drowsiness, coma, seizures - CV: Tachycardia, Arrhythmias, HYPOtension
59
What is the treatment for Respiratory Acidosis?
- Mechanical Vent or Oxygen [Caution in COPD] - Maybe Bicarb if pH is 7.10-7.15
60
What are the characteristics of Respiratory Alkalosis?
- High pH: <7.45 - Decreased PaCO2 - Decreased HCO3
61
What is the pathophyisology for Respiratory Alkalosis?
- "Too much breathing" - Stimulation of respiration - Mechanical Vent [work too hard] - PE - Salicylate Intoxication [could cause Metabolic Acidosis & Respiratory Alkalosis]
62
What are some of the symptoms for Respiratory Alkalosis?
- CNS: Lightheadedness, Confusion, Seizures - decreased cerebral blood flow - muslce cramps - N/V
63
What are some treatment options for Respiratory Alkalosis?
- Ventilation - Sedation [b/c they are breathing too much] - Paralysis
PHRM 864: Therapeutics IV
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