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If a person were to hyperventilate, there would be a/an _________ in CO₂excretion.

increase

If a person were to hypoventilate, there would be a/an _________ in CO₂excretion.

decrease

Normal pO₂

80-100 mmHg

Normal pH

7.35-7.45

Normal pCO₂

40 mmHg

Normal HCO₃

22-26 mEq/L

Acidosis based on a pH _________.

< 7.35

Alkalosis based on a pH __________.

> 7.45

pH < 7.35 with an increased pCO₂

Respiratory acidosis

pH < 7.35 with a decrease in bicarb

Metabolic acidosis

pH < 7.35 with a low bicarb and low pCO₂

Compensated metabolic acidosis

pH < 7.35 with a high pCO₂and a high bicarb

Compensated respiratory acidosis

pH is >7.45 and a low pCO₂

Respiratory alkalosis

pH is >7.45 and a high bicarb

Metabolic alkalosis

pH is >7.45 and the bicarb and pCO₂are high

Compensated metabolic alkalosis

pH is >7.45 and the pCO₂and bicarb are both low

Compensated respiratory alkalosis

Mild acidosis pH range

7.30-7.34

Moderate acidosis pH range

7.20-7.29

Severe acidosis pH range

<7.20

Mild alkalosis range

7.46-7.50

Moderate alkalosis range

7.51-7.60

Severe alkalosis range

>7.60

Anion gap=

[Na+] - [Cl- + [HCO₃]

7 possible etiologies of metabolic acidosis with elevated anion gap

Methanol ingestion, Uremia, Diabetic ketoacidosis, Propylene glycol ingestion, Ischemia with lactic acidosis, Ethylene glycol ingestion, Salicylate intoxication (MUDPIES)

Normal anion gap

12

6 possible etiologies of metabolic acidosis with a normal anion gap

Hyperalimentation, Acetazolamide, Renal tubular acidosis, Diarrhea, Ureterosigmoidostomy, and Pancreatic fistula (HARDUP)

Metabolic acidosis compensation rule

pCO₂decreases by 1-1.5 mmHg below normal (40 mmHg) for every 1 mEq/L decrease in HCO₃below normal (24 mEq/L)

Two "types" of metabolic alkalosis

cholride resistant and chloride sensitive

In order for metabolic alkalosis to be chloride resistant, it must have a urine chloride of _________.

>20 mMol/L

In order for metabolic alkalosis to be chloride sensitive, it must have a urine chloride of ___________.

<10 mMol/L

Etiologies of chloride resistant metabolic alkalosis

Excessive mineralocorticoid activity, Hyperaldosteronism, Cushing's syndrome, Bartter's syndrome, Severe potassium depletion

Etiologies of choride sensitive metabolic alkalosis

GI disorders, diuretic therapy, cystic fibrosis, correction of chronic hypercapnia

Metabolic alkalosis compensation rule

pCO₂increases by 0.6-0.7 mmHg above normal (40 mmHg) for every 1 mEq/L increase in HCO₃above normal (24 mEq/L)

Etiologies of Acute respiratory acidosis

Impaired perfusion, impaired ventilation, CNS depression, spinal cord injury

Etiologies of Chronic respiratory acidosis

impaired ventilation, muscular problems, strokes, tumors, MS

Clinical manifestations of respiratory acidosis

Headache, papilledema, abnormal reflexes

Acutely compensated respiratory acidosis rule

HCO₃increases by 1 mEq/L above normal (24 mEq/L) for every 10 mmHg increase in pCO₂above normal (40 mmHg)

Chronically compensated respiratory acidosis rule

HCO₃increases by 4 mEq/L above normal (24 mEq/L) for every 10 mmHg increase in pCO₂above normal (40 mmHg)

Etiologies of respiratory alkalosis

hypotension, stroke, head trauma, pulmonary embolism, congestive heart failure, pneumonia, physical increase in ventilation, medications (salicylates, nicotine, catecholamines)

Clinical manifestations of respiratory alkalosis

lightheadedness, confusion, nausea, vomitting, arrythmias, slight increase in potassium

Acutely compensated respiratory alkalosis rule

HCO₃decreases by 2-3 mEq/L below normal (24 mEq/L) for every 10 mmHg decrease in pCO₂below normal (40 mmHg)

Chronically compensated respiratory alkalosis rule

HCO₃decreases by 5 mEq/L below normal (24 mEq/L) for every 10 mmHg decrease in pCO₂below normal (40 mmHg)

What is the main determinant of systemic pH?

bicarbonate/carbonic acid buffer system

pH is >7.45 and the bicarb is low and the pCO₂is high

mixed acid base respiratory and metabolic alkalosis

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