Patho - Class 8 (Part 1)

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Acid is a compound that forms ___

hydrogen ions

More H+ ions = more ___

acidic

Base is any compound that ___ with H ions in a solution

combines

Metabolic ___ occurs with a decrease in bicarbonates and a buildup of lactic acid

acidosis

acidosis is what pH

less than 7.35

metabolic acidosis happens with ___, ketosis, and kidney disorders

diarrhea

Three main causes of metabolic acidosis: increased acid ___, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids

production

Diabetic Ketoacidosis → build up of ___ bodies, increasing the risk for metabolic acidosis

ketone

Chronic Renal Failure is a risk for metabolic acidosis due to ___ and insufficient renal bicarbonate production in relation to the number of acids synthesized by the body

reduced bicarbonate reabsorption

With chronic hypoxia, metabolic and hypercapnic acidosis develop along with considerable ___ formation and pH falling to below 6.8

lactate

___ can increase metabolic acidosis and thus result in a reduction of urinary citrate excretion

obesity

diarrhea can cause metabolic acidosis due to loss of ___

bicarbonate

electrolyte disturbances caused by prolonged ___ or severe dehydration can cause metabolic acidosis

vomiting

___ overdose causes body to not produce ATP, leading to raised lactate and ketone bodies (therefore making the pH acidic)

aspirin

significant ___ ingestion results in low serum bicarbonate level

methanol

what are some neuro changes in metabolic acidosis

altered LOC, confusion, coma

what is a skin change that can occur in metabolic acidosis

jaundice

what can be used to treat metabolic acidosis

Sodium bicarbonate

you need to treat underlying cause in metabolic acidosis, for e.g. hydration for DKA, diuretics, or kayexalate. what does kayexalate do?

increases fecal potassium excretion through the binding of potassium in the lumen of the gastrointestinal tract

do not give ___ with diarrhea

kayexalate

Metabolic alkalosis occurs when bicarbonate ion concentration ___, causing an elevation in blood pH

increases

metabolic alkalosis an occur with excessive vomiting, dehydration or ___ disorders

endocrine

vomiting can cause metabolic alkalosis because there is a loss of ___, which are rich in hydrochloric acid (HCl)

gastric secretions

Whenever a hydrogen ion is excreted, a bicarbonate ion is __ in the extracellular space

gained

 Administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause ___, for e.g. baking soda, or meds for indigestion such as Tums

metabolic alkalosis

when potassium is low, potassium shifts out of cells, which makes hypokalemia a risk for metabolic alkalosis why?

H ions will attempt to shift into cells to maintain balance which will raise blood pH

Just like in vomiting, ___ also generates metabolic alkalosis by the loss of gastric secretions, which are rich in hydrochloric acid (HCI)

nasogastric (NG) suction

Metabolic alkalosis may not show any ___

symptoms

signs of metabolic alkalosis that are ___ to acidosis include disorientation, coma

similar

numbness, vomiting, diarrhea, peripheral swelling, fatigue, ___ sensation, and agitation, seizures are more signs of metabolic alkalosis

tingling

in metabolic alkalosis you can use __ to help with vomiting if that is the cause

antiemetic

___ is a systemic and urinary acidifying agent that is converted to ammonia and hydrochloric acid through oxidation by the liver

ammonium chloride

Intravenous (IV) ammonium chloride is a treatment option for ___ cases of metabolic alkalosis

severe

___ also appears to be safe and effective in patients with metabolic alkalosis following treatment of respiratory acidosis from exacerbations of chronic obstructive pulmonary disease (COPD)

Acetazolamide

___ occurs when breathing is inadequate (alveolar hypoventilation) and the lungs are unable to excrete enough CO2 causing PaCO2 or respiratory acid builds up

respiratory acidosis

The extra CO2 combines with water to form carbonic acid, causing a state of acidosis - a common occurrence in ___

emphysema

The ___ activate its compensatory process (albeit slow, often 24 hours or more) by increasing the excretion of metabolic acids through urination, which increases blood bicarbonate

kidneys

acute respiratory acidosis occurs within __

24 hr

acute respiratory acidosis occurs immediately. Left untreated, symptoms will get progressively worse and can be ___

life threatening

chronic respiratory acidosis occurs over time and does not cause symptoms because the body ___ to the increased acidity

adapts

For example: the kidneys produce ___ bicarbonate to help maintain balance in chronic respiratory acidosis

more

If the person develops another illness, this may cause chronic respiratory acidosis to ___ and become acute respiratory acidosis

worsen

Respiratory acidosis is typically caused by an underlying disease or condition. This is also called ___

respiratory failure or ventilatory failure

Hypoventilation is a ___ in ventilation which increases the concentration of carbon dioxide in the blood and decreases the blood’s pH (brain trauma, coma, hypothyroidism, myxedema)

decrease

in chronic respiratory acidosis in COPD patients, the body tries to compensate by ___ more bicarbonate to overcome acidosis

retaining

Excess ___ causes the pH of the blood and other bodily fluids to decrease, making them too acidic (pneumothorax, pneumonia, status asthmaticus)

carbon dioxide

___ can also be a cause of respiratory acidosis

drug intake

Altered level of consciousness occurs in respiratory acidosis in response to ___

encephalopathy/cerebral edema

confusion, ___, drowsiness can occur in respiratory acidosis

stupor

Disorientation, ___, or even focal neurologic signs can occur in respiratory acidosis

headaches

when the lungs can’t remove all of the carbon dioxide produced by the body through normal metabolism, the blood becomes acidified, leading to increasingly serious symptoms, from sleepiness to ___

coma

shaking or jerking muscle movements like tremors and ___, an inability to maintain the posture of part of the body, also occur in respiratory acidosis

asterixis

___ may be used to reverse some types of airway obstruction causing respiratory acidosis, like those linked to asthma and COPD

bronchodilators and corticosteroids

in the case of obesity hypoventilation syndrome (causing respiratory acidosis), ___ may be necessary to reduce abnormal compression of the lungs

significant weight loss

Maintain adequate hydration in respiratory acidosis and provide intravenous ___ and electrolytes as ordered

fluids

Provide mechanical ventilation through ___ supplementation

oxygen

in respiratory acidosis, manage ___ through the use of Kayexalate

hyperkalemia

acidosis causes potassium to move from cells to extracellular fluid in exchange for hydrogen ions, and alkalosis causes the ___ movement of potassium and hydrogen ions

reverse

Respiratory alkalosis can result from ___, the lungs excrete too much carbonic acid that results increases pH

hyperventilation

Since respiratory alkalosis occurs ___, the kidneys do not have time to compensate

quickly

Neurological symptoms such as confusion, paresthesia, and cell membrane excitability occur when the blood pH, CSF, and ICF increases ___

acutely

Panic attacks and anxiety - patients who are hyperventilating are at risk for ___

respiratory alkalosis

___ may manifest as hyperventilation, which increases risk for respiratory alkalosis 

fever

in brain stem damage, the cranial arteries contract which reduce Co2 in the blood, increasing the risk for respiratory alkalosis through ___

central neurogenic hyperventilation

___ occurs most often as a response to hypoxia, metabolic acidosis, increased metabolic demands, pain, or anxiety

hyperventilation

hyperventilation is a ___ response to DKA which can induce respiratory alkalosis

compensatory

Progesterone levels are increased during ___. Progesterone causes stimulation of the respiratory center, which can lead to respiratory alkalosis

pregnancy

___ causes respiratory alkalosis and, by an independent mechanism, metabolic acidosis

salicylate toxicity

numbness occurs due to increased ___ irritability in which a person loses feeling in a particular part of their body (respiratory alkalosis)

neuromuscular

___ or prickling sensation that is usually felt in the hands, arms, legs, or feet, but can also occur in other parts of the body can also happen with respiratory alkalosis

tingling

what heart symptom can happen with respiratory alkalosis

palpitations

Tetany, ___ contraction of muscles (respiratory alkalosis)

involuntary

body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled actions of the body called ___ (respiratory alkalosis)

convulsions

Signs and symptoms of ___ may cause: cardiac arrhythmias, conduction abnormalities, paresthesia, hyperreflexia, convulsive disorders, muscle spasms, muscle twitching, tetany (respiratory alkalosis)

hypokalemia and hypocalcemia

The treatment for respiratory alkalosis depends on the underlying ___

cause

Administering an opioid pain reliever or antianxiety medication to ___ hyperventilation

reduce

___ such as breathe from the diaphragm and abdomen, rather than chest wall

breathing exercises

After massive aspirin ingestions, aggressive gut decontamination, including gastric ___ (cleaning out gastric area) (treating respiratory alkalosis)

lavage

correct hypokalemia and hypocalcemia to treat ___

respiratory alkalosis

providing ___ to help keep a person from hyperventilating

oxygen

Normal pH is ___

7.35-7.45

Below 7.35 is acidic, above 7.45 is ___

alkalotic

Bicarbonate (HCO3) is a ___, makes body more alkalotic

base

Hydrogen ions are another form of ___, found in stomach acid and urine

acid

Decrease in __ = decrease in exhaling = increase in CO2

respiratory rate

Kidneys will ___ HCO3 and retain H+ if experiencing alkalosis

excrete

Intestines hold more ___, so if you have diarrhea, you are excreting the HCO3 → acidosis due to leftover acid

base

Hydrogen ions maintain ___ and the speed of metabolic enzyme reactions

membrane integrity

The ___ of carbon dioxide (PaCO2) is one of several measures calculated by an arterial blood gases (ABG) test

partial pressure

The lungs flush acid out of the body by ___ CO2

exhaling

Increasing and decreasing the respiratory rate alters the amount of CO2 that is breathed out, and this can affect blood pH within ___

minutes

Bicarbonate is excreted and reabsorbed by the ___

kidneys

The respiratory system compensates for changes in pH by changing ___ (rate of respirations)

ventilation

The values for PaCO2 and bicarbonate will vary from normal levels in an attempt to maintain a ratio of ___

20:1

Hyperventilation ___ the CO2 concentration (and therefore the H+ concentration) of the blood, causing respiratory alkalosis

reduces

Hypoventilation ___ the CO2 concentration (and the H+ concentration), causing respiratory acidosis

increases

WHAT ARE TOP 2 ACTIONS TO TAKE IN PNEUMONIA

Draw blood gases and insert IV and give antibiotics

With ___, the alveoli in one or both lungs fill with pus and fluids (exudate), which interferes with the gas exchange - 'consolidation of the lung’

pneumonia

CRP value is ___ with cases of bacteria pneumonia

elevated