blood gases

dissociates the bicarbonate (HCO3) and a hydrogen ion, Bicard diffuses into  the blood, inside the RBC needs to gain a negative ion so chloride comes in 

carbonic anhydrase

can donate a hydrogen ion

acid

can accept a hydrogen ion

base

completely or almost completely dissociates into a hydrogen ion and its conjugate base in aqueous solution, usually have weak conjugate bases

strong acid 

only slightly dissociated in aqueous solution, usually have strong conjugate bases

weak acid

mixture of substances in aqueous solution. Usually, a weak acid and its conjugate base, that can resist changes in hydrogen ion concentration when strong acids or bases are added

buffer 

high pH =

low [H]

Acidemia (ACIDOSIS) - pH =

<7.35

Alkalemia (ALKALOSIS) - pH =

>7.45

Perfect pH =

7.35-7.45

volatile acids, eliminated by lungs, both aerobic, H + HCO3

glucose, fat

fixed acid, anaerobic, eliminated by kidneys, H + lactate

glucose

fixed acid, aerobic, eliminated by kidneys, H + sulfate

cysteine

fixed acid, aerobic, eliminated by kidneys, H + phosphate

phosphoprotein 

Regulated by: Chemical buffer systems, Lungs: eliminate CO2, Kidneys: eliminate H+, reabsorb/generate HCO3

pH

All buffer pairs in a homogeneous solution are in equilibrium with the same hydrogen ion concentration

isohydric principle

holds onto bicarbonate and then CO2 =

acidic trash

buffer system: Transcellular H+/K+ exchange system

bicarbonate 

buffer system: Intracellular proteins and blood proteins, Assist with intracellular pH regulation

protein

buffer system important for the regulation of urine pH

phosphate

Increased PCO2, Increased carbonic acid, Increased H+ = low pH (<7.35), Increased bicarbonate

respiratory acidosis

Decreased PCO2, Decreased carbonic acid, Decreased H+ = high pH (>7.45), Decreased bicarbonate

respiratory alkalosis 

Respiratory disorders involve an alteration in —-, reflecting an increase or decrease in alveolar ventilation

PaCO2

bicarbonate is —— related to pH, As pH goes up, bicarbonate goes up

directly

common causes of ——: depression of respiratory control centers, neuromuscular disorders, chest wall retraction, lung restriction, pulmonary parenchymal diseases, airway obstruction

respiratory acidosis 

common cause of ——-: central nervous system, drugs or hormones, pulmonary diseases, bacteremia, fever, over ventilation with mechanical ventilators, hypoxia, high altitude

respiratory alkalosis

pH is —— related to CO2 levels, As CO2 rises= pH goes down

inversely

Increased H+ = low pH (<7.35), Decreased bicarbonate, Heavier breathing causes decreased PCO2

metabolic acidosis

Decreased H+ = high pH (>7.45), Increased bicarbonate, Lighter breathing causes increased PCO2

metabolic alkalosis 

Metabolic disorders produce an alteration in the serum ——and results from the addition or loss of nonvolatile acid or alkali

bicarbonate concentration

Normal bicarbonate =

22-28

Increased bicarbonate is the COMPENSATION to —-

respiratory acidosis

DECREASED bicarb is the COMPENSATION for —( trying to get rid of base, excrete bicard)

respiratory alkalosis 

Heavy breathing ( increases RR and tidal volume) is compensation for—

metabolic acidosis

Lighter breathing ( slowr RR) is compensation for—-

metabolic alkalosis

mEq of acid or base needed to titrate 1 liter of blood to a pH of 7.4 at 37ºC if the Pco2 were held constant at 40 mmHg. It is a measure of HCO3 excess or deficit

base excess or deficit

a calculation used to measure the difference between positive ions and negative ions in the blood, [Na+] - ([Cl-] + [HCO3-], is important in determining the cause of metabolic acidosis

anion gap

normal anion gap is

12 + or - 4

If the anion gap is greater than — mEq/L: Lactic acidosis, ketoacidosis or organic anions, Renal retention of sulfate, phosphate, or urate, Decreased [K+], [Ca++], and/or [Mg++]

16

cause of metabolic acidosis Ingested drugs or toxic substances (—-), Methanol, Alcohol, Salicylates, Ethylene glycol

increased anion gap

cause of metabolic acidosis: Loss of bicarbonate ions (—-), Diarrhea, Pancreatic Fistulas, Renal dysfunction

normal anion gap

cause of metabolic acidosis: Inability to excrete hydrogen ions (——), Renal dysfunction

increased anion gap

cause of metabolic acidosis: Lactic acidosis (——-), Hypoxemia, Anemia, carbon monoxide, Shock (hypovolemic, cardiogenic, septic, etc.), Strenuous exercise, Acute respiratory distress syndrome (ARDS)

increased anion gap

cause of metabolic acidosis: Ketoacidosis (——), Diabetes mellitus, Alcoholism, Starvation

increased anion gap

Metabolic acidosis with high anion gap USUALLY =

diabetic ketoacidosis

Too many tums can cause =

metabolic alkalosis

causes: ingested drugs or toxic substances, loss of bicarbonate ions, inability to excrete hydrogen ions, lactic acidosis, ketoacidosis

metabolic acidosis 

causes: loss of hydrogen ions, ingestion or administration of excess bicarbonate or other bases

metabolic alkalosis

Metabolic acidosis leads to —— alveolar ventilation

increased

Metabolic alkalosis leads to —-alveolar ventilation

decreased

The respiratory ——-operates very rapidly (within minutes) to partially correct metabolic acidosis or alkalosis

compensatory mechanism

Normally, the kidneys secrete about — mEq of hydrogen ions and reabsorb about — mEq of bicarbonate daily

70

Renal mechanisms in —-: by excreting fixed acids and by retaining filtered bicarbonate.

acidosis

Renal mechanisms in —-: by decreasing hydrogen ion excretion and decreasing the retention of filtered bicarbonate

alkalosis

The renal compensatory mechanisms for acid-base disturbances operate much —-than respiratory mechanisms, renal compensatory responses to sustained respiratory acidosis or alkalosis may take 3-6 days

slower

determines respiratory contribution. A high level means the respiratory system is lowering the pH and vice versa

PaCO2

denotes metabolic/kidney effect. An elevated—- is raising the pH and vice versa

bicarbonate

If the pH is acidotic, look for the number that corresponds with a lower pH, If it is a respiratory acidosis, the CO2 is —, If it is a metabolic acidosis, the HCO3- is ——

high, low

If the pH is alkalotic, look for the number that corresponds with a higher pH, If it is a respiratory alkalosis, the CO2 is —-, If it is a metabolic alkalosis the HCO3- is—-

low, high 

For a respiratory alkalosis the metabolic response should be a low—-

bicarbonate

For metabolic alkalosis, the respiratory response should be a high ——

CO2

If pH and paCO2 are inverse =

respiratory disorder

If pH is acidic and CO2 is high = 

respiratory acidosis 

Is pH low and HCO3 is low =

metabolic acidosis

not responding to any stimuli

obtunded