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Acid Base 2
Respiratory Alkalosis
Hyperventilation
High Altitude
Aspirin
Restrictive Lung Disease
Pulmonary Embolism
Pregnancy
Progesterone
Rib Fracture
Anxiety
2 mins
Respiratory Alkalosis Interventions
Treat Underlying Cause
Mechanically Ventilated Patients
Decrease Tidal Volume and/or Respiratory Rate
Give Adequate Pain Control and Sedation
Hyperventilation Syndrome
Sedatives
Antidepressants
Considerations
Compensatory Drop in Serum Bicarbonate
Calming Breathing Exercises
Correct CO2 Slowly
2 mins
Respiratory Acidosis
Hypoventilation
Increased PaCO2 > 45
Barbiturates Depress Central Respiratory Center of Brain
Opioids Depress Central Respiratory Center of the Brain
Airway Obstruction
Respiratory Muscle Weakness/Paralysis
3 mins
Respiratory Acidosis Interventions
Improve Respiration
Pharmacologic Interventions
Bronchodilators
Respiratory Stimulants
Drug Antagonists
Nonpharmacologic Interventions
Oxygen
Assisted Ventilation
Prevent Complications
1 min
Metabolic Alkalosis
Diuretic use
Vomiting
Antacid
Hyperaldosteronism
26 secs
Metabolic Alkalosis Interventions
Interventions
Treat Underlying Cause
Stop Potassium (K+) Wasting Diuretics
Spironolactone
Acetazolamide
IV Fluids
Sodium Chloride
Replace Potassium (K+)
Considerations
Monitor Respiratory Rate
Monitor Heart Rate
Seizure Precautions
2 mins
Normal Gap Metabolic Acidosis
HARD-ASS
Hyperalimentation
Addison's Disease
Renal Tubular Acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline Infusion
2 mins
Anion Gap Metabolic Acidosis
Pathophysiology
Increased Anion Gap
MUDPILES
Methanol
Uremia
Diabetic Ketoacidosis (DKA)
Propylene Glycol
Isoniazid or Iron
Lactic Acid
Ethylene Glycol
Salicylates
1 min
Metabolic Acidosis Interventions
Interventions
Raise Plasma pH > 7.20
Treat Underlying Cause
Sodium Bicarbonate
Considerations
Follow ABGs
Continuously Monitor Patient
2 mins
How to Interpret Acid Base Disorders
pH, pCO₂, HCO₃ (Bicarbonate)
Step 1
pH
Acidosis
Alkalosis
Step 2
pCO₂
Opposite Direction as pH
Respiratory Acidosis
Respiratory Alkalosis
Step 3
HCO₃ (Bicarbonate)
Same Direction as pH
Metabolic Acidosis
Metabolic Alkalosis
3 mins
Respiratory Acidosis Assessment
Assessment
Decreased pH < 7.35
Increased PaCO2 > 45
Reduced Respirations
Anxiety
Change in LOC
Tachycardia
Cyanosis
Increased Electrolytes
ECG Changes
Muscle Weakness
Hyporeflexia
2 mins
Respiratory Alkalosis Assessment
Assessment
Increased pH > 7.45
Decreased PaCO2 < 35 mmHg
Hyperventilation
Brainstem Stimulation
Head Injury
Shock
Lightheadedness
Tingling Lips or Fingers
Trousseau's
Chvostek's Sign
Anxiety
2 mins
Metabolic Acidosis Assessment
Characteristics
Decreased pH < 7.35
Decreased HCO3 < 22
Signs & Symptoms
Abdominal Pain
CNS Depression
Coma
Hypotension
Arrhythmias
Increased Respirations
Kussmaul Respirations
Flushed, Warm, Dry Skin
Muscle Weakness
2 mins
Metabolic Alkalosis Assessment
Signs and Symptoms
Increased pH > 7.45
Increased HCO3 > 26
Excitable State
Arrhythmias
Paresthesias
Muscle Cramps
Muscle Weakness
Decreased Respiratory Effort
1 min
Type 2 Renal Tubular Acidosis
Proximal Tubule
Pathophysiology
Inability To Reabsorb Bicarbonate
ETIOLOGY
Fanconi Syndrome
Sporadic Type
Familial Types
Autosomal Recessive
Acetazolamide
Characteristics
Decreased Urinary pH
Hypokalemia
Treatments
Treat Underlying Disorder
Alkali Therapy
4 mins
Renal Tubular Acidosis Type 4
Characteristics
Aldosterone Resistance
Decreased Aldosterone Production
Causes Of Hypoaldosteronism
Addison’s Disease (Primary Adrenal Insufficiency)
Hyporeninism
Causes Of Aldosterone Resistance
Trimethoprim-Sulfamethoxazole
Potassium Sparing Diuretics
Labs
Hyperkalemia
Low Urine pH
Diminished Ammonium (NH4) Urinary Excretion
Treatment
Furosemide
Fludrocortisone
5 mins
Distal Renal Tubular Acidosis (Type I)
Pathophysiology
Distal Tube
Defect in H+ Secretion
Labs
Increased Urinary pH
Urinary pH >5.5
Hypokalemia
Causes
Amphotericin B Toxicity
Autoimmune Disease
Lithium
Obstruction Of The Urinary Tract
Complication
Kidney Stones
Treatment
Bicarbonate
3 mins
Indications for Urgent Dialysis (AEIOU)
Signs and Symptoms
AEIOU Mnemonic
Acidosis
pH < 7.1
Electrolyte Imbalances
Symptomatic Hyperkalemia
> 6.5 mEq/L
Ingestion
Overload (Volume)
Uremia
Encephalitis
Pericarditis
2 mins
Addison's Disease
Mechanism
Chronic 1° Adrenal Insufficiency
Atrophy
Destruction
Symptoms
Deficiency In Cortisol And Aldosterone
Skin Hyperpigmentation
Increased POMC
Hypotension
Hyperkalemia
Acidosis
Addisonian Crisis
Diagnosis
ACTH (Cosyntropin) Stimulation Test
Treatment
Exogenous Cortisol
2 mins
Winter's Formula
Evaluates Respiratory Compensation
Used in Metabolic Acidosis
Equation
(HCO3 x 1.5 ) + 8 plus-minus 2 = PCO2
Steps
Bicarbonate (HCO3) x 1.5
+ 8
± 2
= Expected Value for PCO2
2 mins
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