In the Henderson-Hasselbach equation, if HCO3- goes up, what happens to pH?
Increases
7.19/63/55/23
Uncompensated respiratory acidosis w/ hypoxemia
2 causes of Respiratory Acidosis
Inadequate drive to breathe
Sedatives/Narcotics
Medullary dysfunction
Obesity Hypoventilation Syndrome
Trauma
Inadequate bellows function
Neuromuscular disease
Obstructive lung disease
Severe kyphoscoliosis
Increased deadspace or excessive CO2 production
7.52/32/59/25
Uncompensated respiratory alkalosis w/ hypoxemia
Calculate the PAO2 of a patient in Boise Idaho on RA with a normal PaCO2
85 mm Hg
Describe the process of what happens when we give additional bicarbonate?
The additional bicarbonate will convert into CO2 and H2O. The patient must be able to compensate for the increased PaCO2 levels.
7.38/60/61/34
Fully compensated respiratory acidosis w/o hypoxemia
2 causes of non-gap acidosis
Hyperchloremic Acidosis, diarrhea, renal tubular acidosis, pancreatic fistula, administration of Diamox
7.19/49/102/18
Combined acidosis w/o hypoxemia
Name the 3 indices of oxygenation
P/F
A-a difference
a/A ratio
Please state the CO2 hydration equation
H+ + HCO3- = H2CO3 = CO2 + H2O
7.35/35/96/18
Fully compensated metabolic acidosis w/o hypoxemia
2 causes of metabolic alkalosis
Loss of acid or gain of base
lots of vomiting or NG suction
diuretics
loss of potassium and/or chloride
administration of bicarb
7.16/85/57/29
Partially compensated respiratory acidosis w/ hypoxemia
What is the 60-90 rule?
At a SaO2 level of 90% the PaO2 should be 60 mmHg
Clinical rule of thumb for changes in PaCO2
0.08 change in pH/10 torr change in CO2
7.48/42/111/30
Uncompensated metabolic alkalosis w/o hypoxemia
4 causes of gap acidosis
Methanol
Uremia
Lactic acidosis
Ethylene glycol
Propylene Glycol
Aspirin
Ketoacidosis (DKA)
7.33/33/96/17
Partially compensated metabolic acidosis w/o hypoxemia
The Winter's Formula
PaCO2 = 1.5 (HCO3-) + 8 (±2)
Clinical rule of thumb for changes in HCO3- and pH
pH changes 0.15 for each 10 mEq/L change in HCO3
7.14/34/84/14
Metabolic Acidosis with concomitant respiratory acidosis w/o hypoxemia
3 causes of respiratory alkalosis
Hypoxemia
Pain
Fever (despite increased CO2 production)
Anxiety
Iatrogenic (Treatment caused)
IPPB, IS, Mechanical Ventilation
7.53/16/140/12
Glucose 233
Na+ 144
Cl- 101
TCO2 10
BUN 13
Creat. 2.3
Lactate 19.2
Ammonia RFH
Bilirubin RFH
Metabolic acidosis w/ concomitant respiratory alkalosis w/o hypoxemia based upon patient history
Clinical rule of thumb for changes in HCO3- and PaCO2 (Both acute and chronic)
HCO3 increases 1 mEq/L acutely /10 torr increase in PCO2
HCO3 increases 4 mEq/L chronically/10 torr increase in PCO2