Acid-Base balances

Mechanisms of Acid-Base

Acids: give up or donate electrons (bicarbonate)

Bases: accept hydrogen electrons

*Atrial blood: slightly alkaline (7.35-7.45)

^over 7.8 fatal

Regulation of pH

Chemical buffer system: bicarbonate, phosphate, proteins (hemoglobin)

•Intracellular

•Extracellular

•Short duration

Respiratory control mechanisms: Hypovenalation and hyper

•^within minutes, regulate acids by levels of CO2, carboniate acid (vary rate of respiration)

•^twice as effective than chemicals

•Renal control mechanisms: kidneys

•^slow, hours, long-term to maintain acid-base balance

*production of bicarbonate and absorb acids to keep or excert

Buffers

-Chemical: Bicarb, PO4, protein

-Respiratory: Regulate CO2

-Renal: Regulate HCO3

Interpretation of ABGs

1.Evaluate pH: 7.35-7.45

2.Analyze PaCO_{2   : 35-45}

3.Analyze HCO₃^{–    :  22-26}

4.Determine if patient is compensating

5.Assess the PaO₂ (80—100)and O₂ saturation (95%).

Respiratory alkalosis

The pH is ↑ and the PaCO₂ is ↓

^Panic attack, Acute hypoxia/ischemia, hypotension

^Tachycardia, decrease in bicarbonate and hydrogen

*Increase bp and heart rate, decrease in cerebral blood flow (seizures, coma)

-pH: more than 7.45 and CO2 less than 35

*Treatment: Breathe in paper bag

Respiratory alkalosis pt 2

• Causes: TACHYPNEA 

- T = Temperature increase 

- A = Aspirin toxicity 

- C = Controlled ventilation excessive 

- H = Hyperventilation 

- Y = Yelp (pain, anxiety, fear) 

- P = Pneumothorax 

- N = Neurological damage 

- E = Embolism in lungs 

-A = Ascending in altitude  

Symptoms = Dizziness, light-headness, confusion, headache, Tachy, Dyrsrhytmias (hypokalemia), Nausea, vomiting, diarrhea, epigastric pain, tetany, numbness, tingling of extremities, hyperreflexia, seizures, and hyperventilation

Respiratory acidosis

the pH is ↓ and the PaCO₂ is ↑

-impair alveolar ventilation

-Hypoventalation: brain injury, drug overdose, CPOD, Acute respiratory syndrome, airway obstruction

-Cellular: increase CO2 and combine with water to form carbonic acid to decrease acid

-Decrease in oxygen saturation

-Brain: Breathe to increase in order to decrease CO2

-Increase blood flow to brain, celebral edema, CN depression, kidneys to concerserve bicarbonate and sodium to form sodium bicarbonate to buffer the hydrogen

Aerobic --> Anaerobic (Lactic acid production to further worsen the acidosis)

-Nausea, edmea, hyperkalemia

-pH: less than 7.35 and CO2 high than 45

-Bronchi dislators, oxygen

Respiratory acidosis pt 2

• Causes: DEPRESS

- D = Drugs like opiods/ sedatives 

- E = Edema in lungs 

- P = Pneumonia 

- R = Respiratory center of brain damage

- S = Spasms of bronchial tubes (asthma) 

- S = elasticity of alveolar sac damaged (COPD) 

• Symptoms = Lethargy, Confusion, Dizziness, Headache, Coma, drop in BP, Vfib (hyperkalemia), warm flushed skin, seizures, and hypoventilation with hypoxia 

Metabolic alkalosis

pH and HCO₃⁻ are ↑ and the PaCO₂ is ↑ or normal

*-pH: more than 7.45 and bicarbonate more than 26

*Excess loss of GI tract and GI sunctioning

-Hypokalemia

*Used of loop diuretics: loss of hyrdogens, postassium, etc and caused kidneys to excrete hyrdoegn ions, sodium, and water

-Bicarbonate will acculumate and above 28, renal will not absorb and go into the urine

*Neuroicgical nightmare: Confusion, loss of reflexes, coma, cardiac changes

Treatment: Discontinue diuretics, and meds to stop nausea/vomit 

*Acidzomide: increase renal excereation of sodium bicarbonate

Metabolic alkalosis pt 2

• Causes = Alkali 

- A = Acid loss via stomach 

- L = Low chloride level 

- K = K+ loss 

- A = Aldosterone elevated 

- L = Loop & thiazide diuretics 

- I = Infusing too much sodium bicarb IV 

• Symptoms = Irritability, Lethargy, Confusion, Headache, Tachy, Dyrsrhytmias (hypokalemia), Nausea, vomiting, anorexia, tetany, tremors, tingling of fingers and toes, muscle cramps, hypertonic muscles, seizures, and hypoventilation 

Metabolic acidosis

pH and HCO₃⁻  are ↓ and the PaCO₂ is ↓ or normal

*pH: less 7.35 and Bicarbonate less than 22

*Hyperkalemia

-Central nevorus system, depresses, impacts K+ and Calcium

-Cardio

-Cardiac arrest and coma, shock state

*Accumlation of carboic acid or loss of bicarbonate à excess hydrogen ions

*Kidneys function will try to produce hydrogen ions in renal to be in the urine (acidic)

-Signs: Hypervalation (COSMA) à blowing off more CO2, fruity odor in breath (catabolosim of fats/carbs)

Treatment: replace the sodium bicarbonate

Metabolic acidosis pt 2

• Causes = ACIDS 

- A = Accumulation of lactate

- C = Chronic diarrhea 

- I = Impaired renal function 

- D = Diabetic ketoacidosis 

- S = Salicylates toxicity  

Symptoms = Similar neuro signs of respiratory acidosis, drop in BP, dysrhythmias (hyperkalemia), cold clammy skin, nausea, vomiting, diarrhea, abdominal pain, muscle weakness, and Kussmaul breathing (deep rapid respirations)

S phase

Period of DNA synthesis and replication of the chromosomes

-10 to 12 hours

M Phase

involves formation of the mitotic spindle and cell division with formation of two daughter cells

-less than an hour

G1

Stage during which the cell is starting to prepare for DNA replication and mitosis

*protein synthesis and an increase in organelle and cytoskeletal elements

G2

pre-mitotic phase

-Enzymes and other proteins needed for cell division are synthesized and moved to their proper sites