Flashcards
acid base balance
Cards in this deck (75)
- 1*Blood pH is slightly basic (alkaline), with a normal range of 7.36-7.44bicarbonate [a salt containing the anion HCO 3 –]; an acid neutralizer, to balance the acids produced.
- 2-breakdown of fats produces a natural by-product of an acid. This can occur in starvation as the body uses fats for energy instead of carbohydrates.chronic alcoholism, malnutrition, and diabetic ketoacidosis, Consuming a diet low in carbohydrates and high in fats .......
lead to metabolic acidosis. - 3metabolic acidosis= build up of lactic acid in the blood. this build up occur in these conditions: heart failure, shock, or cancer, Some poisonings and overdoses (aspirin, methanol, or ethylene glycol) also produce symptoms of metabolic acidosis.symptoms of metabolic acidosis:
weakness, malaise, headache, lack of energy, and sleepiness. Breathing may become fast and shallow. Nausea, vomiting, diarrhea, dehydration, and loss of appetite. - 4Diabetic patients with symptoms of metabolic acidosis may also have breath that smells fruity. The patient may lose consciousness or become disoriented. *Severe cases can produce coma and death.Metabolic acidosis could be a symptom brought on by some disorder.
[lack of insulin, a starvation diet, or a gastrointestinal disorder[ such vomiting and diarrhea]].
2/ an indication to more serious problem with major organs, such as kidney, heart, liver failure. - 53/ could be one of the first signs of drug overdose or poisoning.Metabolic acidosis:
disruption of the body's acid/base balance.
** is a pH imbalance in which the body has accumulated too much acid and does not have enough bicarbonate to effectively neutralize the effects of the acid. - 6acidosis occur in the blood, so when Blood pH below 7.35 it confirms the condition. - increasing levels of potassium, glucose, ketones, or lactic acid indicate the presence of metabolic acidosis.-if level of bicarbonate in the blood low, less than 22 mEq/L= metabolic acidosis.
-Urine pH may fall below 4.5= metabolic acidosis. - 7*Treatment focuses first on correcting the acid imbalance by giving attention to the underlying cause: 1/If the patient is diabetic, insulin may be administered. 2/Drugs to control nausea and vomiting. 3/Usually, sodium bicarbonate and fluids will be injected into the blood through a vein.the two main causes of this condition are:
1/ the accumulation of acid and hydrogen ions.
2/ or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues...............
resulting in a decrease in pH. - 8**The optimal acid-base balance is maintained by: 1/ chemical buffers, 2/biologic activities of the cells, 3/and effective functioning of the lungs and kidneys.**Acidosis usually occurs secondary to some underlying disease process.
- 9**compensated acidosis: a condition in which the compensatory mechanisms have returned the pH toward normal.-diabetic acidosis:
a metabolic acidosis produced by accumulation of ketones in uncontrolled diabetes mellitus. - 10-hypercapnic acidosis= respiratory acidosis. -hyperchloremic acidosis= renal tubular acidosis.-lactic acidosis:
[ a metabolic acidosis ]occurring as a result of excess lactic acid in the blood.
*occurs most commonly in disorders in which oxygen is inadequately delivered to tissues, such as shock, septicemia, or extreme hypoxemia, [as lack of O2 stimulate overly fermintation]. - 11con; **but it can also result from exogenous or endogenous metabolic defects that affect lactic acid level or the pathway of respiration.**iatrogenic acidosis:
may result from administration of drugs, such as urinary acidifiers, or anesthetic agents which depress respiration. - 12*metabolic acidosis: any of the types of acidosis resulting from accumulation in the blood of keto acids (derived from fat metabolism) at the expense of bicarbonate.acid gain as in [diabetic ketoacidosis, lactic acidosis, poisoning, or failure of the renal tubules to reabsorb bicarbonate].
while bicarbonate loss as in [diarrhea or a gastrointestinal fistula]. - 13*The breath may have a fruity odor owing to the presence of acetone= a symptom of metabolic acidosis.-A rising pulse rate and a drop in blood pressure frequently occur as a result of hypovolemia in the diabetic-acidotic patient.
-cardiac arrhythmias can be caused by increased calcium levels in the blood. - 14renal tubular acidosis (RTA): a metabolic acidosis resulting from impairment of the reabsorption of bicarbonate by the renal tubules, characterized by low plasma bicarbonate and high plasma chloride; the urine is alkaline. [ as bicarbonate reabsorption is impaired so it's excreted out of the body by urine make the last more alkaline].**A Gastrointestinal Fistula:
is an abnormal opening in the gut that results in an abnormal connection between the gut and other organs.
The condition causes the intestinal or stomach contents to ‘leak out’. - 15**gut= (stomach or intestines).as GI fistula lead to Diarrhea
& Dehydration which will lead in sever cases to metabolic acidosis. - 16** the causes of the presence of this opening is due to: -Bowel surgery. -Inflammatory bowels diseases such as Crohn’s disease and ulcerative colitis. Cancer. Radiation exposure. Trauma. Obstruction of the intestinal tract. birth defects.Enterocutaneous Fistula (ECF) one of the GI fistula
- 17-fistula:ناسور. abnormal or surgically made passage.**In response to an increase in the hydrogen ion concentration in body fluids, the respiratory rate increases, causing more carbon dioxide to be released from the lung.
- 18-an acute obstruction of the airways. or a chronic condition involving the organs of respiration causes interference with the exhalation of the carbon dioxide.... **would be the main reasons for respiratory acidosis.then carbon dioxide accumulates in the blood and unites with water to form carbonic acid.
- 19*compensatory chemical buffer systems depend on: 1/normal blood circulation 2/and tissue perfusion for optimal effect.Acute respiratory acidosis:
occurs when there is a relatively sudden malfunction of respiratory activities, as in:
1/upper airway obstruction, a
2/cute infections and inflammation of the lung and bronchial tissues,
3/and pulmonary edema. - 20-In acute respiratory acidosis: the compensatory chemical buffer systems are of limited benefit in restoring the acid-base balance*Chronic respiratory acidosis:
results from gradual and irreversible loss of ventilatory function,
as in chronic obstructive pulmonary disease (COPD).
Although the patient in this condition does have an increased retention of CO2, there is time for the kidneys to compensate by retaining bicarbonate and thereby maintaining a pH within tolerable limits. - 21respiratory acidosis divided into: acute. and chronic.*Drugs that depress the respiratory center: (narcoticsالمخدرات, hypnoticsالمنومات , and tranquilizersالمهدئات= reduce tension or anxiety.)
- 22**starvation acidosis: a metabolic acidosis due to accumulation of ketones following a severe caloric deficit. نقص في السعرات الحراريةin Respiratory Acidosis:
the problems lead to it must be involving:
1/the lungs and respiratory system.
2/ or signals from the brain that control breathing. - 23one example of how this condition occur; When this exchange of oxygen for carbon dioxide is impaired,...... the excess carbon dioxide forms an acid in the blood. *The condition can be acute with a sudden onset, or it can develop gradually as lung function deteriorates.**Conditions that cause chronic metabolic alkalosis can also trigger respiratory acidosis.
- 24**symptoms of metabolic alkalosis, may include: cyanosis; a bluish or purplish discoloration of the skin due to inadequate oxygen intake. **Severe cases of respiratory acidosis can lead to coma and death.-Respiratory acidosis symptoms:
the most notable symptom will be slowed or difficult breathing.
Headache, drowsiness, restlessness, tremor, and confusion may also occur.
A rapid heart rate, changes in blood pressure, and swelling of blood vessels in the eyes may be noted upon examination. - 25Causes: 1/diseases or conditions that affect the lungs themselves, [such as emphysema, chronic bronchitis, asthma, or severe pneumonia].2/ Blockage of the airway due to swelling, a foreign object, or vomit can induce respiratory acidosis.
- 263/Drugs: like anesthetics, sedatives, and narcotics can interfere with breathing by depressing the respiratory center in the brain.4/ Head injuries or brain tumors:
can also interfere with signals sent by the brain to the lungs. - 275/Conditions that cause chronic metabolic alkalosis can also trigger respiratory acidosis.6/ Such neuromuscular diseases:
as Guillain-Barré syndrome or myasthenia gravis can impair the muscles around the lungs making it more difficult to breathe. - 28**Respiratory acidosis: is an acid imbalance in the body caused by a problem related to breathing.-In this type of acidosis,
the pH will be below 7.35,
The pressure of carbon dioxide in the blood will be high, usually over 45 mmHg. - 29*In patients with chronic lung diseases, this may include use of a bronchodilator or steroid drugs. *Antibiotics may be used to treat infections.*Supplemental oxygen supplied through a mask or small tubes inserted into the nostrils may be used in some conditions, however, an oversupply of oxygen in patients with lung disease can make the acidosis worse.
- 30*overdose of narcotics, the patient may be given a dose of naloxone; a drug that will block the respiratory-depressing effects of narcotics.*Use of mechanical ventilation like a respirator may be necessary.
- 31-this type of acidosis caused by: retention of carbon dioxide; due to inadequate pulmonary ventilation or hypoventilation, with decrease in blood pH unless compensated by renal retention of bicarbonate.- characterized by a low plasma pH resulting from reduced alveolar ventilation. The hypoventilation inhibits the excretion of carbon dioxide, which consequently combines with water in the body to produce carbonic acid, thus reducing plasma pH.
- 32-the main cause; alveolar hypoventilation, could be caused by; drugs, CNS depression, heart disease, lung disease–[eg, COPD], neuromuscular disease–[eg, ALS], diaphragm paralysis, major kyphoscoliosis, Guillain-Barré syndrome, myasthenia gravis, muscular dystrophy, obesity hypoventilation syndrome.Clinical signs:
Cyanosis, wheezing, hyperinflation–ie, barrel chest, ↓ breath sounds, hyperresonance on percussion, prolonged expiration; depressed mental status due to ↑ CO2,
accompanied by seizures, papilledema, dilated conjunctival or facial blood vessels. - 33—
- 34** common causes of decreased alveolar ventilation: 1/l depression of central respiratory center by sedatives;sleep-inducing effect. like; barbiturates or opioids.2/ airway obstruction; including asthma or COPD exacerbations.
3/neuromuscular disorders that cause respiratory muscle weakness or paralysis. - 35-muscle weakness decrease the ability of lungs to perform gas exchange. e,g:ALS; amyotrophic lateral sclerosis.*hypoventilation in COPD involve several mechanism;
ventilation-perfusion mismatching.
[which lead to increase the dead space ventilation]. - 36respiratory alkalosis: reduced carbon dioxide tension in the extracellular fluid caused by excessive excretion of carbon dioxide through the lungs (hyperventilation). *Conditions commonly associated with respiratory alkalosis include pain, hypoxia, fever, high environmental temperature, poisoning, early pulmonary edema, pulmonary embolism and central nervous system disease.-respiratory alkalosis;
Alkalosis resulting from an abnormal loss of CO2 produced by hyperventilation, either active or passive, with يصاحب ذلكconcomitant reduction in arterial bicarbonate concentration. - 37-In cases of metabolic alkalosis, slowed breathing may be an initial symptom. episodes of apnea (not breathing) that may go on 15 seconds or longer. Cyanosis, Nausea, vomiting, and diarrhea may also occur.other symptoms:
irritability, twitching, confusion.
Rapid heart rate, irregular heartbeats, and a drop in blood pressure.
**Severe cases can lead to convulsions and coma. - 38-Metabolic alkalosis could be; brought on by: 1/ vomiting, 2/drugs; the use of steroids or diuretic drugs, or the overuse of antacids مضادات الحموضة or ملين laxatives. 3/can indicate a more serious problem with a major organ such as the kidneys.-Blood pH above 7.45 confirms the condition.
-low Levels of salts like potassium, sodium, and chloride below normal ranges= metabolic alkalosis.
- high levels of bicarbonate in blood usually greater than 29 mEq/L. - 39-Urine pH may rise to about 7.0 = metabolic alkalosis. *if the chloride levels drop, it means that bicarbonte levels has increased according to HCO3-/Cl shift.-Treatment focuses first on correcting the imbalance;
1/An intravenous line may be started to administer fluids (generally normal saline, a salt water solution),
2/Potassium chloride will be administered. - 40* this alkalosis associated with: 1/ an increased arterial plasma bicarbonate concentration. 2/or an excessive loss of acid. [via urine or through persistent vomiting].* increased arterial plasma bicarbonate concentration could be caused by:
an excessive intake of alkaline materials. - 41clinical findings; Slow, shallow breathing.Aetiology
1/Loss of acids [due to hyperemesis, gastric suction]
2/loss of K+[ due to increased renal excretion (e.g., diuretic therapy)],
3/steroid use, the same effect of diuretics.
4/excess/overuse of antacids.
Compensation;
The lungs compensate for metabolic alkalosis by retaining CO2 with slower respiration; the kidneys are less effective than the lungs in compensating for metabolic acidosis, which act by increasing bicarbonate excretion. - 42*Decreased respiratory rate indicates an effort to compensate for alkalosis and may cause respiratory acidosis.**Too-rapid infusion of ammonium chloride may hemolyze red blood cells,
and an excessive dosage may overcorrect alkalosis and cause acidosis. - 43**metabolic alkalosis is associated with loss of gastric acid with excessive vomiting, while: respiratory alkalosis associated with excessive loss of carbon dioxide due to hyperventilation from any cause.one of these conditions cause cause hyperventilation:
physiological response to hypoxia at high altitude. - 44In compensated alkalosis: pH may be normal, with a low blood bicarbonate concentration (due to increased renal excretion) when the cause is respiratory[= hyperventilation].In compensated alkalosis:
pH may be normal, with a raised blood carbon dioxide (due to hypoventilation) when the cause is metabolic. - 45gastric alkalosis: alkalosis due to loss of gastric fluid because of persistent vomiting.-hypochloremic alkalosis:
a metabolic alkalosis in which gastric losses of chloride are disproportionately greater than sodium loss because of corresponding increase in potassium loss. - 46-hypokalemic alkalosis: a metabolic alkalosis associated with a low serum potassium level; retention of alkali or loss of acid occurs in the extracellular (but not intracellular) fluid compartment; although the pH of the intracellular fluid may be below normal.Respiratory alkalosis:
is a condition where the amount of carbon dioxide found in the blood drops to a level below normal range.
it's brought on by rapid, deep breathing = hyperventilation. - 47mechanism: When a person hyperventilates, this exchange of oxygen for carbon dioxide is speeded up, and the person exhales too much carbon dioxide. This lowered level of carbon dioxide causes the pH of the blood to increase, leading to alkalosis.** metabolic acidosis can also trigger hyperventilation leading to respiratory alkalosis.
- 48-conditions related to or lead to hyperventilation: pneumonia, lung disease, or asthma. also associated with anxiety, fever, drug overdose, carbon monoxide poisoning, or serious infections. Tumors or swelling in the brain or nervous system can also cause this type of respiration.-Other stresses to the body, including pregnancy, liver failure, high elevations, or metabolic acidosis can all trigger hyperventilation leading to respiratory alkalosis.
- 49symptoms: Hyperventilation, dizziness, lightheadedness, agitation, spasms, and weakness may be noted.severe respiratory alkalosis:
Seizures, irregular heartbeats, and tetany (muscle spasms so severe that the muscle locks in a rigid position) . - 50*In this type of alkalosis, the pH will be elevated above 7.44, The pressure of carbon dioxide in the blood will be low, usually under 35 mmHg.**Hyperventilation — Rapid, deep breathing, possibly exceeding 40 breaths/minute.
The most common cause is anxiety, although fever, aspirin overdose, serious infections, stroke, or other diseases of the brain or nervous system. - 51- If the alkalosis is related to a drug overdose, the patient may require treatment for poisoning. -Use of mechanical ventilation like a respirator may be necessary.-Other medications may be required to treat fever, seizures, or irregular heart beats.
-Antibiotics may be used to treat pneumonia or other infections. - 52-Hyperventilation due to anxiety may be relieved by having the patient breath into a paper bag. By rebreathing the air that was exhaled, the patient will inhale a higher amount of carbon dioxide than he or she would normally.[this will increase the CO2 levels & relief alkalosis].**In severe cases of respiratory alkalosis,
the patient may experience seizures or heart beat irregularities that may be serious and life threatening. - 53The hyperventilation may be caused by: Some pulmonary causes: are acute asthma, pulmonary vascular disease, and pneumonia. Some nonpulmonary causes: are aspirin toxicity, anxiety, fever, metabolic acidosis, inflammation of the central nervous system, gram-negative septicemia, and hepatic failure.hyperventilation causes:
1/pulmonary
problems.
2/non-pulmonary - 54In the acute stageof respiratory alkalosis: blood pH rises in proportion to the fall in PaCO2, means blood PH will rise.-but in the chronic stage blood PH remains within the normal range of 7.35 to 7.45.
as carbinic acid concentration is normal in the acute stage, & below the normal in chronic stage. - 55carbonic acid: bind the CO2 with water, this will lead to acidosis, that's why when PCO2 fall this would not give the carbonic acid enough time or even quantitiy of CO2 to bind with, as a result this will head to an alkalinge blood PH not acidosis.while in chronic stage:
carbonic acid concentrations are below normal & there's also a low concentration of CO2 that will eventually lead to approximately normal blood pH. - 56in respiratory alkalosis: Sedatives may also be administered to decrease the ventilation rate. **pH > 7.42, HCO3- < 22 mEq/L PaCO2 < 35 mmHg.hypoxemia–severe anemia,
high altitude,
right-to-left shunt,
drugs– such as: [progesterone, methylxanthines, salicylates, catecholamines, nicotine]
hyperthyroidism,
pregnancy,
lung disease– like: pneumo/hemothorax, pneumonia, pulmonary
edema,aspiration, interstitial lung disease,
sepsis, liver failure - 57in all previous conditions they will lead to hyperventilation and as a result respiratory alkalosis.respiratory alkalosis may be compensated by:
1/ increased production of metabolic acids
2/or increased renal excretion of bicarbonate. - 58**metabolic alkalosis is rarely compensated by hypoventilation. **compensated alkalosis: a condition in which the blood bicarbonate is increased or the PCO2 is decreased= respiratory alkalosis. but compensation by the lung and kidneys keeps the blood pH within the normal range.means;
it's a Disorder[= alkalosis] in which there is a change in bicarbonate but the pH of body fluids approaches normal. - 59-uncompensated alkalosis; alkalosis in which the pH of body fluids is elevated because of lack of the compensatory mechanisms of compensated alkalosis.-uncompensated acidosis;
an acidosis in which the pH of body fluids is subnormal, because restoration of normal acid-base balance is not possible or has not yet been achieved. - 60-compensated acidosis: a condition in which the pH of the blood is maintained within normal limits (adult/child: 7.35 to 7.45) although the blood bicarbonate level is below normal or the PCO2 is above normal. This compensation is accomplished by the lungs and/or kidneys altering their functions.so in this case:
lung will increase ventilation to reduce CO2 levels,
while kidney reabsorp bicarbonate to increase their levels in blood. - 61** metabolic alkalosis is rarely compensated by hypoventilation.compensated alkalosis include both alkalosis caused by metabolic or respiratory pathway.
- 62—if there's no air or the partial pressures of all; intrapleural, intrapulmonary, atmospheric are equal,
then the lung will collapse.
no air exchanging.
- 63at FRC; alveolar partial pressure=0mmHg. intrapleural partial pressure= -5cm H20. as intrapulmonary pressure(0mmHg) is higher than intrapleural one, the lung will push out toward the chest, which keeps it from collapse, and give the lung ability to inflate once again.
- 64TPP: transpulmonary pressure; = alveolar pressure - intrapleural pressure. [TPP=PA-IPP].transmural pressure:
the pressure gradient across any tube or sphere.
transmural P = P(inside)- P(outside tube).
this pressure will determine the tube to expand or collapse. - 65when transmural pressure(TMP) is positive: the sphere or tube will distance or expand. while if TMP zero or negative the sphere will collapse.**3 important types of transmural pressure:
1/transpulmonary pressure. [TPP]
2/ transthoracic pressure. [TTP]
3/transrespiratory pressure. [TRP] - 66pneumothorax occur becsuse of penetrating injury at chest wall, in this, the pleural will be in an indirect communication with air leading to third situation of TPP discussed before. IPP= atmpspheric pressure= alveolar pressure =0mmHg.normal values of: at FRC. [functional residual capacity]
1/alveolar pressure= 0mmHg/
2/atmospheric pressure=0mmHg
3/intrapleural pressure=( -5)mmHg. - 67transthoracic pressure; TTP= intrapleural pressure- body surface pressure. means thedifference btw pleural and chest (surface) pressures.
- 68body surface pressure: the pressure on surface area outside the lung and inside the chest wall.**all theses types of pressure calculated at FRC.
**TTp at FRC= -5mmHg.
[-5-0= -5mmHg]. - 69**body surface pressure= atmospheric = mmHg at FRC. *when transthoracic pressure is negative, the lungs deflate or shrink but not collapse.TTP is negative, so chest wall will spring slightly inward.
** at FRC:
*the lung is destindded by (+ TPP),
while chest wall is deflated by(-TTP),
both forces at FRC are equal(resulted fromTPP&TTP)so there's no collapsing or expanding in the lungs. - 70*transrepiratory pressure= alveolar pressure - atmospheric pressure. **at FRC: PA- Patm= 0-0= 0mmHg no net force for expanding or deflating.FRC:
the equilibrium state of the respiratory system. - 71**Contraction of the diaphragm: would decrease intrapleural pressure. & generate a positive intra-abdominal pressure.**fick's low study alveolar-capillary membrane( the rate of diffusion for gases across this membrane)/
- 72fick's low states that rate of diffusion is directly proportional to surface area. means if surface area doubled the rate will increase by 2 fold(i,e it doubles).**respiratory exchange ratio=
volume of CO2 removed by alveoli per minute/ volume of O2 transferred to pulmonary circulation per minute. - 73in normal conditions: exchange ratio= 200(ml/min)/250(ml/min) =0.8**The rate of diffusion varies between oxygen and carbon dioxide.
Carbon dioxide is 24 times more soluble but diffuses through a liquid at a rate that is 1.18 times less than oxygen.
*This results in a total diffusion rate that is 20 times faster than oxygen and reaches an equilibrium between pulmonary capillary and alveolus more quickly than oxygen. - 74-Because of this carbon dioxide diffusion from the blood into the alveolus is not impacted by alveolar thickness as much as oxygen diffusion.**pulmonary vascular resistance:
"the vascular resistance of the pulmonary circulation";
the difference between the mean pulmonary arterial pressure and the left atrial filling pressure divided by the cardiac output. - 75the relationship btw cardiac output and pulmonary vascular resistance is inversely proportional to each other.
Information
- Description
- Flashcards on acid base balance, created by alice zoldiac on 06/05/2018.
- Created by
- alice zoldiac
- Views
- 0
- Rating