_________ and ________ can cause acid-base imbalances as well as losses of fluid and electrolytes.
Vomiting and diarrhea
Why are older adults more prone to acidosis?
Their kidneys are less able to compensate for an acid load and they commonly have decreased respiratory function
When expressing H+ in pH, every increase of 1 (i.e. pH of 7 to pH of 8) equals a _________ increase.
What is the normal ratio of carbonic acid to bicarbonate in the body?
One part carbonic to every 20 parts bicarbonate 1:20
How is acidemia different from acidosis?
Acidemia is a blood pH of less than 7.35 Acidosis is the PROCESS of accumulating acids or elimination of base from the body
How is alkalemia different from alkalosis?
Alkalemia is an arterial pH of more than 7.45 Alkalosis is the PROCESS of accumulating base or eliminating acid
An anion gap is a reflection of normally unmeasured anions in the plasma. It is useful for the differential diagnosis of ___________.
What are the three mechanisms used by the body to regulate acid-base balance?
The buffer system, respiratory system and the renal system
Which acid-base regulatory system reacts to an imbalance within days, but accommodates a persistent imbalance indefinitely?
The renal system
Carbonic acid-bicarbonate, monohydrogen-dihydrogen phosphate, and intracellular and plasma protein are examples of ________ in the body.
Buffers (hemoglobin buffers are also part of this mechanism)
Which component of the buffer system creates NaCl, and sodium biphosphate (NaH2PO4) from acids and forms weaker bases and H2O from bases?
Which part of the buffer system creates CO2, Hydrogen ions (H+), Ammonia (NH3), OH- (hydroxide) and H2O?
Intracellular and extracellular proteins
_________ is a part of the buffer system that shifts Chloride in and out of Red Blood cells in exchange for carbonate.
The ______ acts as a buffer by shifting hydrogen in and out of the cell in exchange for other ions like K+.
The _________ help maintain normal pH by excreting CO2 and water, which are by-products of cellular metabolism.
What is the rate of excretion of CO2 controlled by?
The respiratory center in the Medulla in the brainstem
How do the kidneys compensate for acidosis?
They generate additional bicarbonate and eliminate excess H+
What are the three mechanisms that the kidneys utilize to eliminate acids from the body?
1. they secrete small amounts of free hydrogen into the renal tubule 2. combines H+ with ammonia (NH3) to form ammonium (NH4+) 3. they excrete weak acids
When does the renal compensatory system begin to combat respiratory acidosis?
Within 24 hours, therefore, if the bicarbonate level is within normal limits and the carbonic acid is low, compensation hasn't begun and the condition is a recent development
Anxiety, CNS disorders and mechanical overventilation can lead to what acid-base imbalance?
Why is compensated respiratory alkalosis rare?
In most cases, hypoxemia is aggressively treated which allows no time for the body to begin compensation
T/F Metabolic acidosis occurs when there is an accummulation of carbonic acids from disease processes.
False, metabolic acidosis occurs from a build up of acid other than carbonic acid (like lactic acid and ketoacid)
Metabolic acidosis always results in _______ of bicarbonate, whether the cause is an accumulation of acids or a loss of bicarbonate from body fluids.
What conditions can cause metabolic acidosis?
Diabetic Ketoacidosis and Shock (lactic acid build up)
What can cause metabolic alkalosis?
Severe vomiting and/or diarrhea, consumption of baking soda and oversuctioning of gastric contents
T/F The primary mechanism for compensating for metabolic alkalosis is increased excretion of bicarbonate from the renal system.
False, the primary mechanism is hypoventilation. The kidneys do excrete excess bicarbonate, but it takes some time.
T/F It is possible to have a near normal pH AND have an acid-base imbalance.
True, it is possible to have more than one acid-base imbalance that causes the pH to be near normal
T/F It is not possible to have metabolic acidosis and respiratory acidosis at the same time. Mixed acid-base imbalances involve some form of acidosis (respiratory OR metabolic) with some form of alkalosis.
False. You can have any mix of the four imbalances.
What accounts for many of the clinical manifestations of alkalosis?
Hypocalcemia, which occurs from calcium binding with albumin and lowering the amount that is bioavailable
What patient information can be determined from Arterial Blood Gas (ABG) values?
Their acid base status Their underlying cause of the imbalance Their overall oxygenation status
PaCO2 is considered the ________ component of arterial blood gasses. High levels indicate acidosis, low levels indicate alkalosis.
Which acid-base imbalance? Low plasma pH Elevated PaCO2 Normal or high HCO3- Urine pH is under 6
Which acid base imbalance? High plasma pH Low PaCO2 Normal or low HCO3- Urine pH greater than 6
Which acid base imbalance? Low plasma pH Normal or low PaCO2 Low HCO3- Urine pH less than 6
Which acid base imbalance? High plasma pH Normal or high PaCO2 High HCO3- Urine pH greater than 6
COPD, barbituate/sedative overdose, obesity, severe pneumonia, atelectasis, Guillain-Barre syndrome, and mechanical hypoventilation are all common causes of what acid-base imbalance?
Hypoxia, pulmonary emboli, anxiety, fear, pain, exercise, septicemia, encephalitis, brain injuries, salicylate poisoning and mechanical hyperventilation are common causes of what acid-base imbalance?
Diabetic ketoacidosis, lactic acidosis, starvation, severe diarrhea, renal tubular acidosis, renal failure, GI fistulas, and shock are common causes of what acid-base imbalance?
Severe vomiting, excessive gastric suctioning, diuretic therapy, potassium deficits, excess intake of baking soda, or excessive mineralcorticoids are all common causes of what acid-base imbalance?
Which acid-base imbalance presents with the following symptoms? Drowsiness, disorientation, dizziness, headache, coma, low BP, ventricular fibrillation, warm, flushed skin, seizures and hypoventilation
Which acid base imbalance presents with the following signs and symptoms? Drowsiness, confusion, headache, coma, low BP, dysrhythmias, warm, flushed skin, nausea, vomiting diarrhea, abdominal pain, deep, rapid respirations
What are main differences in signs and symptoms between respiratory acidosis and metabolic acidosis?
Respiratory acidosis causes ventricular fibrillation, seizures, and HYPOVENTILATION...no GI symptoms Metabolic acidosis causes HYPERVENTILATION and GI symptoms (nausea, vomiting, diarrhea), and dysrhythmias
Acidosis, whether metabolic or respiratory, causes high or low Potassium levels?
High, a lot of the cardiac symptoms are from hyperkalemia
Which acid base imbalance presents with the following signs and symptoms? Lethargy, light-headedness,confusion, tachycardia, dysrhythmias, nausea, vomiting, epigastric pain, tetany, numbness, tingling of extremities, hyperreflexia, seizures, and/or hyperventilation
Which acid base imbalance presents with the following signs and symptoms? Dizziness, irritability, nervousness, confusion, tachycardia, dysrhythmias, nausea, vomiting, anorexia, tetany, tremors, tingling of fingers and toes, muscle cramps, hypertonic muscles, seizures, hypoventilation
What are main differences in signs and symptoms between respiratory alkalosis and metabolic alkalosis?
Respiratory Alkalosis: HYPERVENTILATION, epigastric pain, hyperreflexia Metabolic alkalosis: HYPOVENTILATION, anorexia, hypertonic muscles, irritability